Professor Cícero Coimbra

Professor Cícero Coimbra is one of the most brilliant medical minds of present times. His Coimbra Protocol changed the life of thousands of people worldwide.

The development of the Coimbra Protocol started 20 years ago when Professor Cícero saw the beneficial effects that vitamin D did in a Parkinson patient that also had vitiligo. After taking a physiological dose of 10.000IU, the vitiligo lesions had almost disappear. The improvement was remarkable! At is was enough to start the path that led to what is known today as Coimbra Protocol.

At the time, at lot of clinical studies have already been published in medical magazines showing the crucial role vitamin D plays in the pathological processes existent in autoimmune diseases. As the conventional treatment options were not very effective - and still are not -, the evidence that vitamin D might help is of critical importance: it could open a possible therapeutic option for this patients.

During the following years, the protocol was developed step by step, with a very clear goal in mind: autoimmunity does not have to mean disability, loss of quality of life or suffering. All came down to finding a way autoimmune patients could be helped in a more logical, safer and healthier way. Professor Coimbra specialization as a neurologist enabled him to adjust and readjust the treatment plan for patients with multiple sclerosis. As it is suppose to be a progressive, degenerative and unimprovable disease, when patients start to get better, the therapeutic success was clear! Just like this, a conclusion was reached: it is possible to beat autoimmunity!

It wasn't an overnight discovery. This journey lasted more than a decade, until Professor Coimbra reached a treatment plan which could achieve maximum therapeutic effects and minimum side effects. Finally, in 2012, those goals were achieved and the Coimbra Protocol was born. Overall, more than 7000 people from all over the world are being able to fight and win over autoimmunity.

 

 

Vitamin D

Actually, vitamin D is not even a vitamin, as vitamin A or C are.
Curiosamente, Vitamina D não é uma verdadeira vitamina, como o é a vitamina A ou a C.

Remember that cod fish oil you probably took as a child? Well, in the 19th century, it was understood that children suffering from rickets had their condition improved if they would take that same oil. Following this observations, the forth vital element was discovered: vitamin D.

Around the same time, a completely different approach to this epidemic disease that was spreading in the industrialized world found another paramount element to bone's health: the Sun. The more UVB exposure the environment in which the child was living, the fewer and less serious cases of rickets existed. It was then discovered that when skin was exposed to UVB radiation, the same fourth vital element was produced.

When tried both therapies together, the improvements were so incredible that cod fish oil and sun exposure were define as the first line of treatment against bone malformations.

Only with the technological developments of the 20th century scientists were able to clearly identify the molecular structure of the vitamin D and its pathway throughout the body: from the first discovered 25-hidroxivitamin D, another was produced in the kidney, the 1,25-dihidroxivitamin D. Only in the 80's, Dr. Michael Holick (author of The Vitamin D Solution) completed the puzzle, describing the mechanism by which the vitamin D is produced in the skin.

The complete classical pathway is remarkably simple: when the UVB rays touch the skin, they transform a cholesterol-derived substance called 7-dehidrocolesterol in cholecalciferol (the same component present in the cod fish oil). Cholecalciferol is transformed in the liver into Calcidiol or 25-hidroxicolecalciferol which is again processed in the kidney by the 1-alfa-hidroxilase into calcitriol or 1,25-dihidroxicolecalciferol. This is the active hormone. Yes, it is right: vitamin D acts in the body as an steroid hormone!
However, over the last years, the amount of evidence linking vitamin D with a positive effect anywhere in the body is immense. The scientific community started getting suspicious that this skin - liver - kidney pathway was to limited and could not explain the overall effect vitamin D has in the body. Light was shed into it when the 1-alfa-hidroxilase was discovered to be present everywhere in the body. Literally. We have this enzyme in every cell. This means we can activate the vitamin D inside our cells and it can have an effect in every organ! Making it more clear, the vitamin D receptor (VDR) was found everywhere as well. So, the real biological effect of the vitamin D occurs when the calcidiol connect with the VDR and they act on the most elemental process in our body: genetical transcription. In fact, up to 5 and 20% of our genome needs the calcidiol-VDR system in perfect shape to be correctly read. Can you imagined the impact it has on us? Of the 20.000 genes we have, up to 5000 of them need vitamin D to be put in action!

 

Coimbra Protocol

 

Autoimmune diseases just exist because the immune system is not working properly.

The immune system's ultimate job is protection against threats, both internal (for example, cancer) and external (virus and bacteria). It is capable of generating a massive amount of different defense cells and mediators, able to recognize and eliminate a very broad spectrum of agents. Our immunologic network is highly complex, just second to neurologic system's.

Immune responses acting on our behalf and be roughly divided into Th1 and Th2. The first creates an inespecific inflammatory state and activates further immune cells. The second, on the other hand, mainly activates B-cells and antibody-driven imune reactions. Both are critical for an proper immune action. Simply put, Th1 and Th2 can be considered the good imunologic responses.

However, the increased level of knowledge and the development of new technology allowed the scientific community to better understand the immune system. It became clear that another type of immune response was present in autoimmunity. The autoattack was driven by an specific interleukin called IL17, leading to the identification of the Th17 response. Despite a small beneficial role, this is a pathologic action of the immune system and it has been associated with a lot of different autoimmune conditions: multiple sclerosis, rheumatoid arthritis, lupus, Crohn's, colitis, psoriasis, Hashimoto's, vitiligo... In theory, all autoimmunity is associated with Th17 responses. So much so that the goal of prescribed treatments is to reduce and eliminate it. Even though different drugs may work in different ways, the method is the same: suppressing autoimmunity, suppressing the immune function. You guessed it: they are the immunesuppressors. Because of the way they work, one of the most common side effects of conventional treatments is infections.

While diving into the published data, Professor Coimbra found articles like this, showing that the vitamin D could have an important role in the regulation of that Th17 pathway (specifically through the transcription modulation of IL17), suggesting its therapeutic use against autoimmunity. In fact, it is not the only one: a simple search on medical databases will deliver thousands of articles showing relationship between blood vitamin D levels, its action and different autoimmune conditions, like multiple sclerosis, rheumatoid arthritis, lupus, Hashimoto's thyroiditis, Crohn's disease, colitis, psoriasis, vitiligo, spondilitis, ... . 

In the words of Professor Coimbra, "vitamin D is not an immunossuppressor but an imunomodulator, it always works for our body. Through the effect of the genetical transcription, vitamin D optimizes the cell function. As this process is the basis of everything that a cell does and because we do not have imprinted in our genes the information to target pathologically our own cells, by marking it possible to perfectly read our genes vitamin D can control and turn off the Th17 responses. Not only does the vitamin D reduce this pathologic pathway but it also increases our defense ability! It does not just shut down our immune system but it also improves it all together!

However, epidemiologic data does not support the hypothesis that blood levels of vitamin D is the answer for the autoimmune question. And here is way: the worldwide level of vitamin D is low. As an example, in Portugal, more than 2/3 of the population have low levels of vitamin D. Because we do not have that much people with autoimmune conditions, there must be something else going on. The piece of the puzzle that is missing is the genetical variability.

In fact, autoimmune patients have small genetical changes, called single nucleotide polymorphisms (SNP), that create a resistance in the system they are codifying. In the vitamin D pathway, SNPs in the vitamin D receptor (VDR) have been identified and associated with different autoimmune diseases. Even though it is not completely clear yet, it seems that SNPs in the VDR creates a shift in its configuration, leading to an impaired function. It is probably that change that allows the Th17 response to get bigger and more active.

Imagine that you have a dam built in a river. To keep the it running towards the sea, you have to have enough water to overcome the dam and enabling the river to flow. It is a very simple explanation of why the Coimbra Protocol uses high dosage of vitamin D. Because of the resistance created by the SNPs, by taking high amounts of this hormone we can overcome this "glitch" and optimize the immune function and system. That means turning off Th17 responses and, by doing it, we can turn off autoimmunity. In order words, Coimbra Protocol can make your immune system so health and optimized that it stops attacking your body!

Emotional Stress

If you suffer from any autoimmune condition, ask yourself this question: do the symptoms get worse when you are more anxious or stressed? Do you have flares or relapses after highly emotionally stressed periods?

Well, almost every patient seeking the Coimbra Protocol point to emotional stress as one of the major triggers of their disease. Even though we cannot limit the trigger of autoimmunity to stress, there are plenty of  published papers  supporting the connection of emotional status and stability and autoimmune diseases. They just go in favor of what Professor Coimbra has been saying for years!

This close relationship is also very important in terms of efficacy and success of the treatment. Emotional stress is the main reason people do not achieve the best clinical outcome. Vitamin D does wonders in optimizing the cell function and turning off the auto-attack but it cannot overcome the nasty effect of mental instability. It is like gas on a fire: if you have a burning fire going on, fire fighters can usually solve the problem. However, even if the all the best men are tackling it, if some one is putting gas on the fire, they will not be able to extinguish it. Autoimmunity is the fire, vitamin D the fire fighter, stress the gas.

Every single action that may lower the stress and help patients achieve a better emotional balance is worth trying. From meditation and acupuncture to psychotherapy or psychopharmacology, all may play an important role.

Just keep in mind: emotional stress is the main reason why the disease stays active on the Coimbra Protocol.

Toxicity

When talking about the Coimbra Protocol's side effects, it is extremely important to clarify one thing: there are NO toxic effects triggered directly by the vitamin D molecule by itself. All the toxic effects are caused by the calcium levels in the body. It is true that high levels of vitamin D increase the absorption of calcium from our diet and, therefore, do increase the blood level of calcium. It is that increase that create havoc in our system: calamitous consequences may come from it.

However, if we can control the amount of calcium that is absorbed, we keep the system safe even when taking high-dosage of this magnificent hormone.

Assuring the safety of the patient is critical, obviously. For that reason, patients of the Coimbra Protocol are obliged to adopt strategies that prevent hypercalcemia - high blood levels of calcium. Fortunately, the life-style changes are quite simple and easily done: 

1. Diet - The goal is simple: reduce the amount of calcium ingested. By reducing the amount of calcium that we eat, we control the amount of calcium absorbed to the blood, avoiding hypercalcemia. These are the mandatory changes:

a. No dairy (or calcium-enriched vegetable beverages)

b. Nuts and Seeds

c. Green vegetable juices

2. Hydration - If the diet reduces the amount of calcium absorbed, the increment of water intake helps "cleaning the kidneys". The goal is to dilute the calcium that goes through them. For that reason, every one on the protocol must consume a minimum of 2,5 liters of liquids daily, including water, tea, coffee, "healthy" juices. Also, it is very important to pay attention to concentration of calcium in the water: it should be lower than 25mg/L.

3. Drugs and supplements- Over the last months, Professor Coimbra has found that several supplements and pharmaceutical drugs increase the calcium levels and compromise patients safety. For that reason, patients are requested to completely avoid Vitamin D supplements and inform their practitioner if they are taking lithium or anastrozole.

These measures are mandatory and non-negotiable. It is the only way we can guarantee the Coimbra Protocol will not be harmful. Looking from a different point of view, in this amazing treatment, any side effect is optional and will only exist if the patient want.