Article: March 22, 2012 by John Cannell, MD

To date, we have much research on vitamin D, the majority being epidemiological studies (observations of populations/groups of people) and some mechanistic studies (vitamin D actions). These kinds of studies show that vitamin D deficiency may be a risk factor for widespread diseases and also that vitamin D and its metabolites have mechanisms to keep the body functioning properly and ward off diseases.

However, public policy makers have decided that this kind of proof is inadequate, and that we need to treat vitamin D like a new drug. The gold standard of proof of efficacy of a new drug is a randomized controlled trial (RCT). Such trials include randomization to one of several groups (so that everyone in the groups are similar to begin with), then the "blinding" of both the patients and the researchers. This means that neither the patients nor the researchers know if they are getting/giving vitamin D or a sugar pill (placebo).

If it is a serious disease being studied, an objective third party opens the code periodically to see if either the vitamin D is helpful or harmful, as it would be unethical to continue the trial if one of either conditions were occurring. Sometimes randomization is not possible, so then, it simply becomes a controlled trial. Researchers then either publish or present their results or do both. Our informal count to date is over 50 positive controlled trials of vitamin D.

Researchers do not always first publish their findings in journals. Researchers sometimes first announce their findings at professional meetings and then later submit them for publication. Like you, we have to depend on the media to get information about RCTs first announced at meetings. Not all health reporters recognize the importance of RCTs, so some go unpublicized.

However, one that missed oblivion was Dr Faud Baroody's recent trial on allergic rhinitis. This University of Chicago researcher simply gave 4,000 IU/day to the treatment group and standard treatment to both groups and discovered vitamin D helps allergic rhinitis. You can read about it yourself, so I won't repeat what Medscape already provided.

Johnson K. Oral Vitamin D Boosts Intranasal Steroid Effect in Rhinitis. Medscape 3/12/2012

Such positive RCTs are becoming so numerous, so positive, so one-sided, that the pressure on the Food and Nutrition Board should already be mounting. However, unless forced by political means, I doubt they will meet again for ten years, no matter how many RCTs lay in the dust behind them.

Article: March 12, 2012 by John Cannell, MD

Scientists dismiss many open studies in psychiatry with skepticism for good reason; they are often falsely positive because of something called the "placebo effect." That is, if you take 50 depressed teenagers and give them vitamin D and 50% improve, one has no way of knowing if it was the vitamin D or the placebo effect.

Placebo effects occur for lots of reasons, mainly because psychiatric diseases, with few exceptions, tend to get better over time. This is particularly true of major depression, where the placebo response may be as high as 50% (for reasons that are unclear, researchers see less placebo effect in obsessive-compulsive disorder). In depression, the placebo effect means that almost half your subjects will tend to improve with placebo, or the measurement scales you use will show a 50% improvement in the average patient.

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Article: March 7, 2012 by John Cannell, MD

Painful periods or dysmenorrhea have always been a common problem for women. Millions of women suffer 4-7 days of severe abdominal cramps together with irritability, insomnia, depression, and generalized pain requiring medications like ibuprofen and antidepressants. Dr. Antonio Lasco and colleagues at the University of Messina in Italy took the first step in what I predict will be a major trip forward in relieving the suffering of these women by publishing their results from yet another randomized controlled trial.

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Article: March 1, 2012 by John Cannell, MD

One of the most replicated findings in vitamin D research is that the higher your vitamin D, the less you weigh; the lower your vitamin D, the more you weigh. Conventional wisdom says that fat-soluble vitamins, like D, dissolve themselves in fat and disappear from the blood.

Another explanation is even simpler: if you dissolve a teaspoon of sugar in a glass of water, it will be sweeter than if you dissolve it in a quart of water. That is, anything (vitamin D) dissolved in a limited mass (fat) will be more concentrated.

Body weight and vitamin D blood levels

But what about the possibility of vitamin D playing a causative role, not just an associative role, in obesity and body mass? That is, to a limited extent, does vitamin D act like a diet pill? Last week, Dr. Selehpour of the Tehran University of Medical Sciences found some interesting results in her randomized controlled trial.

Salehpour A, Shidfar F, Hosseinpanah F, Vafa M, Razaghi M, Hoshiarrad A, Gohari M. Vitamin D3 and the risk of CVD in overweight and obese women: a randomised controlled trial. Br J Nutr. 2012 Feb 9:1-8. [Epub ahead of print]

In this RCT of 77 overweight women, they gave half a small dose of vitamin D (1,000 IU/day), and half a placebo. In just 12 weeks, the vitamin D group had lost five more pounds than the control group. They also found improved scores in lipoprotein/cholesterol ratios for better heart health in the vitamin D group verses the placebo. Which brings some readers to a question: "If I want to diet, how much vitamin D should I take?"

First, 5,000 IU/day is for otherwise healthy adults weighing average adult weight (125-200 pounds). If you're above this weight, however, 32 IU per pound per day is a good rule of thumb (as reported in the "Body weight and vitamin D blood levels" blog above. This means that a 300lb person would need 10,000 IU/day, though it wouldn't surprise me if they needed more. Only way to know is to test blood levels. As your weight decreases, it is important to reduce your dose.

I doubt vitamin D is a classic diet pill. It may work by increasing your activity as your "get up and go" is back. Just lying on the sofa popping vitamin D pills will get you nowhere, however. Follow that urge to take the walk, clean out the garage, and take that weekend trip.

Recent evidence supports an association between vitamin D deficiency and hypertension, peripheral vascular disease, diabetes mellitus, metabolic syndrome, coronary artery disease, and heart failure. The effect of vitamin D supplementation, however, has not been well studied. We examined the associations between vitamin D deficiency, vitamin D supplementation, and patient outcomes in a large cohort. Serum vitamin D measurements for 5 years and 8 months from a large academic institution were matched to patient demographic, physiologic, and disease variables. The vitamin D levels were analyzed as a continuous variable and as normal (>30 ng/ml) or deficient (<30 ng/ml). Descriptive statistics, univariate analysis, multivariate analysis, survival analysis, and Cox proportional hazard modeling were performed...

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Vitamin D - a natural hormone, rather than a vitamin - is known to be instrumental in bone development, but also may protect against cancer and autoimmune diseases, as well as fight infections.

Not just important for building strong bones, an international team of scientists has found that vitamin D also plays an essential role in the body's fight against infections such as tuberculosis.

A potentially fatal lung disease, tuberculosis is estimated to cause 1.8 million deaths annually and especially impacts those with reduced immunity such as HIV-infected individuals, according to the World Health Organization.

In an interesting twist, people with darker skin traditionally have had a higher susceptibility to tuberculosis and areas of Africa lead the world with the highest infection rates. Scientists believe this may be partly due to the skin pigment melanin, which is more abundant in darker skin that shields the body from absorbing ultraviolet rays, but also reduces vitamin D production.

Vitamin D -- a natural hormone, rather than a vitamin-- is known to be instrumental in bone development, but also may protect against cancer and autoimmune diseases, as well as fight infections.

Published online Oct. 12 in the peer-reviewed journal, Science Translational Medicine, researchers examined the mechanisms that govern the immune system's ability to kill or inhibit the growth of pathogens such as M. tuberculosis, the bacteria causing tuberculosis.

The team found that T-cells, which are white blood cells that play a central role in immunity, release a protein called interferon- that triggers communication between cells and directs the infected immune cells to attack the invading tuberculosis bacteria. However, this activation requires sufficient levels of vitamin D to be effective.

Researchers next tested serum taken from blood samples in healthy humans with and without sufficient vitamin D and found that the immune response was not triggered in serum with lower vitamin D levels, such as those found in African Americans. But, when adequate vitamin D was added to deficient serum, the immune response was effectively activated.

Scientists found that there was an 85 percent reduction of colony-forming tuberculosis bacteria in human macrophage cells that were effectively treated with interferon- in the presence of sufficient vitamin D.

"Over the centuries, vitamin D has intrinsically been used to treat tuberculosis. Sanatoriums dedicated to tuberculosis patients were traditionally placed in sunny locations that seemed to help patients -- but no one knew why this worked," said first study author Dr. Mario Fabri, who conducted the research at UCLA and is currently at the Department of Dermatology at the University of Cologne, Germany. "Our findings suggest that increasing vitamin D levels through supplementation may improve the immune response to infections such as tuberculosis."

The team notes that vitamin D may help both innate and adaptive immunity, two systems that work synergistically together to fight infections.

Previous research by the team found that vitamin D played a key role in the production of a molecule called cathelicidin, which helps the innate immune system kill the tuberculosis bacteria. Humans are born with innate immunity, which is the preprogrammed part of the immune system.

The current research findings demonstrate that vitamin D is also critical for the action of T-cells, key players in adaptive immunity, a highly specialized system that humans acquire over time as they encounter different pathogens.

"The findings of our previous research with innate immunity provided us with a new opportunity to take a look at the effects and role of Vitamin D with acquired immunity, both critical systems of human defense," said senior investigator Dr. Robert Modlin, Klein Professor of Dermatology and Distinguished Professor of Medicine and Microbiology, Immunology and Molecular Genetics, Chief of Dermatology, Vice Chair for Cutaneous Medicine and Dermatological Research, Department of Medicine, David Geffen School of Medicine at UCLA.

Surprisingly, researchers found that although both the innate and acquired immune systems start out by using different receptors to trigger a complex chain reaction in infected cells to kill the tuberculosis bacteria, both converge early on to follow the same pathway that utilizes vitamin D.

Specifically, in the current study, researchers discovered that T-cells released interferon, which not only activated the infected cells called macrophages to generate cathelicidin and other proteins to kill tuberculosis, but also ensured that these proteins, like a honing device, are delivered to the compartment of the cell where the bacteria resides. The cells then gobble-up the infectious areas containing bacteria.

"These current findings provide the first credible mechanistic explanation for how vitamin D critically contributes to acquired T-cell immunity that protects us from infections, particularly tuberculosis," said Modlin.

Researchers also note that this is the first study to demonstrate that the protein interferon activates cells to kill the tuberculosis bacteria.

"The role of interferon has been speculated for years in numerous studies, but previous research didn't take into account that sufficient vitamin D was needed to help interferon- trigger an effective immune response," said study author Dr. John Adams, professor of orthopaedic surgery, Geffen School of Medicine. "Now we understand better how this chain reaction works."

According to the team, the findings are also important because they show that this unique pathway to fight tuberculosis cannot be studied in a mouse model. These nocturnal animals are not exposed to the sun to absorb vitamin D and as a result, use an entirely different pathway than humans to kill tuberculosis.

Fabri notes that most people with tuberculosis are asymptomatic, perhaps due to successful immunological control and sufficient vitamin D to keep the infection from developing into active disease.

"At a time when drug-resistant forms of tuberculosis are emerging, understanding how to enhance natural innate and acquired immunity through vitamin D may be very helpful," said co-author Barry Bloom, former dean of the faculty at the Harvard School of Public Health, Distinguished University Service Professor, Jack and Joan Jacobson Professor of Public Health, Harvard School of Public Health, Department of Immunology and Infectious Diseases and Department of Global Health and Population.

According to researchers, the next step is to initiate clinical trials to learn whether vitamin D supplementation augments resistance to host resistance to tuberculosis and other infections.

View the original article at Nutrition Horizon

Thursday, August 04, 2011 - Byron Richards, CCN

A new study with breast cancer patients has widespread implications for any person with chronic pain—high-dose vitamin D1 may be able to significantly reduce the pain.

It is typical that doctors prescribe aromatase inhibitors to women with estrogen-positive breast cancer. A common adverse side effect is extreme pain in the bones and joints, a traumatic inflammatory result from reduced levels of estrogen. Doctors have often found that women with breast cancer have low vitamin D in the first place. Interestingly enough, they happened to notice that many of the women with a high vitamin D intake did not experience the expected chronic pain. This led them to conduct a double-blind placebo-controlled randomized phase II trial providing 50,000 IU of vitamin D per week for two months. The women who received high-dose vitamin D realized a dramatic reduction in pain. What's more, they did not only realize a dramatic reduction in pain—they also did not lose any bone density.

These findings have widespread implications to anyone with chronic pain as Vitamin D is the key nutrient that prevents your immune system from overheating, leading to an inflammatory fire resulting in ongoing pain. It is theoretically expected that receiving vitamin D, at some dose, could help put out such a fire. This would seemingly be a far better and less costly approach than poisoning the immune system with the typical remedies currently used to control pain. This is the first study, however, to prove this point. The bottom line is while this approach is used to relieve pain in breast cancer patients, it has obvious implications for any sort of autoimmune pain, such as rheumatoid arthritis or pain in general.

Before taking this amount of vitamin D, individuals should have their blood tested and retested every several months to ensure their vitamin D levels do not elevate out of range. The goal is to try to reach a vitamin D blood level that is toward the higher end of the normal range (the typical lab range is 30 to 100 ng/mL). Many studies indicate, however, that ideal vitamin D levels are between 50 and 80 ng/mL Individuals with any type of chronic pain may therefore want to consume high-dose vitamin D to target a blood level closer to 80 ng/mL.

I am not suggesting that vitamin D is the only important issue relating to pain. I am saying that it is a key nutrient that plays a role in how well your body handles the inflammatory heat of pain, before the frying pan starts to cook the goose. It is a far better strategy than that of the medical profession—employing expensive, toxic remedies as part of their lucrative pain-treatment industry—and may help individuals to use much lower doses of such drugs or none at all.

1 High Dose Vitamin D Lowers Pain in Breast Cancer Patients Breast Cancer Research and Treatment Antonella L. Rastelli, Marie E. Taylor, Feng Gao, Reina Armamento-Villareal, Shohreh Jamalabadi-Majidi, Nicola Napoli and Matthew J. Ellis.

Vitamin D testing may help men gauge their heart disease and stroke risk, as a new study from a team of Harvard School of Public Health researchers has found that low levels of the nutrient may be linked to increased odds of suffering a cardiovascular event.

After studying more nearly 119,000 adults for a period of 20 years, the researchers found that men who got more than 600 international units per day were 16 percent less likely to develop heart disease or suffer a stroke.

The researchers said that previous studies have shown that vitamin D plays a role in the function of cardiovascular tissue, but there was little evidence to suggest that higher levels of the nutrient were directly associated with improved health outcomes.

They added that their findings show that increasing vitamin D consumption for men should be considered a major part of reducing heart disease and stroke risk.

"These observations suggest that a higher intake of vitamin D is associated with a lower risk of cardiovascular disease in men but not in women," the team wrote in their report. "Further research is needed to confirm these findings and to elucidate a biological basis for potential sex differences."

ScienceDaily (June 18, 2011)

Laboratory-grown gingival cells treated with vitamin D boosted their production of an endogenous antibiotic, and killed more bacteria than untreated cells, according to a paper in the June 2011 issue of the journal Infection and Immunity. The research suggests that vitamin D can help protect the gums from bacterial infections that lead to gingivitis and periodontitis. Periodontitis affects up to 50 percent of the US population, is a major cause of tooth loss, and can also contribute to heart disease. Most Americans are deficient in vitamin D.

His interest piqued by another laboratory's discovery that vitamin D could stimulate white blood cells to produce natural proteins that have antibiotic activity, Gill Diamond of the UMDNJ -- New Jersey Dental School, Newark, showed that vitamin D could stimulate lung cells to produce LL-37, a natural antibiotic protein, and kill more bacteria. That suggested that , vitamin D might help cystic fibrosis patients. Next, in the new research, he showed that vitamin D has the same effct on gingival cells.

Then, Diamond found that vitamin D also stimulates gingival cells to produce another protein, called TREM-1, which had not been well-studied, but which was thought to be made by white blood cells. He found that it boosts production of pro-inflammatory cytokines.

The new research also showed that vitamin D coordinates expression of a number of genes not previously considered to be part of the vitamin D pathway. Those genes may be involved in additional infection-fighting pathways. A more comprehensive understanding of how vitamin D carries out this regulation at the molecular level -- something Diamond hopes to investigate -- will enable targeted therapies using vitamin D, he says.

Interestingly, Diamond also found that lung and gum cells appear to have the ability to activate inactive forms of vitamin D, says Diamond. "This means that we may even be able to use vitamin D therapy topically, if that proves true."
Vitamin D has become a hot area of research in recent years. In addition to infectious diseases, studies suggest that it has protective effects against autoimmune diseases, and certain cancers.

Diamond says that after he began conducting research on vitamin D, he began taking it as a supplement. Since then, "I have had only one cold in four years, and that one lasted only three days," he says. "Other people I've met who have done the same have seen similar results. We are trying to figure out how it's working, and what other infectious diseases can be mitigated by it."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by American Society for Microbiology, via EurekAlert!, a service of AAAS.

Journal Reference:

L. McMahon, K. Schwartz, O. Yilmaz, E. Brown, L. K. Ryan, G. Diamond. Vitamin D-Mediated Induction of Innate Immunity in Gingival Epithelial Cells. Infection and Immunity, 2011; 79 (6): 2250 DOI: 10.1128/IAI.00099-11

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of AGD Nutrition or its staff.

Vitamin D Physiology

Different Forms of Vitamin D

To understand the vitamin D endocrine system one needs to be familiar with the different forms of vitamin D, namely cholecalciferol, calcidiol, and calcitriol.

Cholecalciferol (vitamin D3)

Cholecalciferol is the naturally occurring form of vitamin D. Cholecalciferol is made in large quantities in your skin when sunlight strikes your bare skin. It can also be taken as a supplement.

Calcidiol (25(OH)D3 or 25D3)

Calcidiol (25-hydroxyvitamin D) is a prehormone in your blood that is directly made from cholecalciferol. When being tested for vitamin D deficiency, calcidiol is the only blood test that should be drawn. When someone refers to vitamin D blood levels, they are referring to calcidiol levels. Your doctor can order calcidiol levels but the lab will know calcidiol as 25-hydroxyvitamin D.

Calcitriol (1,25(OH)2D3 or 1,25D3)

Calcitriol (1,25-dihydroxyvitamin D) is made from calcidiol in both the kidneys and in other tissues and is the most potent steroid hormone derived from cholecalciferol. Calcitriol has powerful anti-cancer properties. It is sometimes referred to as the active form of vitamin D. Calcitriol levels should never be used to determine if you are deficient in vitamin D.

 

Vitamin D Endocrine System

 

Cholecalciferol Forms In The Skin

D-Lite, Renew, & SunSplash UV/Tanning Systems Increase your blood vitamin D level the way nature intended, with ultraviolet B light! Cholecalciferol is formed in the skin when ultraviolet light of the correct wavelength, UVB, strikes bare skin. Enormous quantities of cholecalciferol are rapidly made in the skin if: the sun is high in the sky (midday and the summer season), your skin is not covered by clothes or sunblock, you stay in the sun until your skin just begins to turn pink (not red), you are not behind glass. Glass blocks virtually all UVB, preventing vitamin D from being made.

Studies show that if you go out in the summer sun in your bathing suit until your skin just begins to turn pink, you make between 10,000 and 50,000 units of cholecalciferol in your skin. Professor Michael Holick of Boston University School of Medicine has studied this extensively and believes a reasonable average of all the studies is 20,000 units. That means a few minutes in the summer sun produces 100 times more vitamin D than the government says you need! As discussed in other pages, this is the single most important fact about vitamin D.

The skin does another amazing thing with cholecalciferol. It prevents vitamin D toxicity. Once you make about 20,000 units, the same ultraviolet light that created cholecalciferol begins to degrade it. The more you make, the more destroyed. So a steady state is reached that prevents the skin from making too much cholecalciferol. This is why no one has ever been reported to develop vitamin D toxicity from the sun, though it is possible when taking vitamin D orally.

Animals Form Cholecalciferol In Their Fur

Fur bearing animals and many birds make cholecalciferol in their fur or feathers since sunlight can not get to their skin. Interestingly, mammals and birds then eat the cholecalciferol by licking their fur (grooming) or rubbing their beaks on their feathers (preening). So, when you take cholecalciferol by mouth, you are doing what a number of other mammals do!

Calcidiol Made in Liver

After it is made in the skin, or taken by mouth, cholecalciferol is transported to the liver where it is metabolized into calcidiol or 25(OH)D. Calcidiol is now thought by some scientists to have steroid hormone properties. It certainly helps maintain your blood calcium levels. But calcidiol's main importance is that it is the storage form of vitamin D. Calcidiol is what fills your vitamin D gas tank. If your serum calcidiol level is less than 40 ng/mL, your tank is low and should be filled up, keeping it that way unless you have a rare medical condition called vitamin D hypersensitivity.

In order to understand why you should keep your vitamin D tank full, you need to understand the next step in the metabolism of cholecalciferol. After your liver turns cholecalciferol into calcidiol, calcidiol follows one of two pathways. The first pathway takes priority—as your life literally depends on it—but the second pathway is causing all the excitement. However, if your tank is low, most of your calcidiol takes the first pathway.

Calcitriol Made in Kidneys

The first pathway leads to the kidney, where calcidiol is turned into calcitriol. Calcitriol is a potent steroid hormone, in fact, it is the most potent steroid hormone in the human body. A steroid hormone is simply any molecule in the body that is made from cholesterol and that acts to turn your genes on and off. They are always important to health, always need to be handled with care, and are often quite potent.

Calcitriol made by the kidney circulates in the blood to maintain your blood calcium levels. Calcium is vital to the function of the cells in the body, without enough calcitriol in the blood calcium levels will fall and illness will set in. Therefore, the first priority for calcidiol is to go to the kidney where it makes enough calcitriol to secrete into the blood in order to regulate serum calcium.

More Calcitriol Produced in Tissues

The second vitamin D pathway leads to your tissues and that is where all the action is. All of the amazing health benefits of vitamin D discovered in the last 10 years are from vitamin D going down the second pathway. If any calcidiol is left over—that is, if your tank is full and your kidneys are getting all the calcidiol they need to maintain serum calcium—then calcidiol is able to take another pathway, one that leads directly to the cells. This path is only now being fully understood and is causing excitement all around the world, especially concerning cancer. These are the autocrine (inside cell) and paracrine (around the cell) functions of the vitamin D system.

These functions are crucial to understanding why you should keep your vitamin D tank full. If you only have a small amount of calcidiol in your blood, virtually all of it goes to your kidney, which then makes extra calcitriol to keep your serum calcium levels from falling. Almost no calcidiol gets to your tissues to make tissue calcitriol.

Tissue Calcitriol A Cancer Fighter

But when your tank is full, the left over calcidiol goes to the many cells in the body that are able to make their own calcitriol to fight cancer—and they do so with gusto! In fact, they appear to make as much calcitriol as they can. The more calcidiol they get, the more calcitriol they make. The step is not rate-limited by its product (calcitriol) and is thus uncontrolled. No other steroid hormone system in the body works this way; the manufacture of calcitriol in the tissues is unique. This is the second most important fact about vitamin D.

Other steroids limit their own production by inhibiting the very chemical reactions that make them. For example, a chemical reaction in the body turns cholesterol into progesterone, a female hormone. When enough progesterone is made, progesterone shuts down (inhibits) the chemical reaction so no more progesterone is made. This is called negative feedback. This occurs with all other steroids, somewhere in the metabolic process. If it didn't, the body would not be able to precisely regulate steroid hormone levels.

It does not appear to occur with calcitriol in the tissues! Throughout the entire range of normal calcidiol levels, tissue calcitriol levels continue to increase.

This is a crucial piece of information, because it has such profound implications for the normal state of human affairs. Just as modern humans have been living (and dying) with historically low levels of calcidiol in their blood, their tissues have been living (and dying) with historically low levels of calcitriol. And calcitriol is the most potent steroid hormone in the human body. It turns genes on and off at a dizzying rate, genes that are either making proteins that are essential to fighting cancer or genes that are making proteins that are promoting diseases like cancer.

Built-in Toxicity Protection

What prevents tissue calcitriol levels from getting too high? Something has to or your tissues would make too much. One thing that helps is called catabolism, or breakdown. The more calcitriol made, the more metabolized and excreted in the bile. But that does not prevent too much from being made in the first place.

Let us go backwards for a minute. One possibe way of limiting calcitriol in the tissues is by limiting the amount of calcidiol in the blood. That is, maybe the chemical reaction that turns cholecalciferol into calcidiol in the liver is rate-limited, or has a negative feedback loop?

No, it does not. In normal humans, the more cholecalciferol in the blood, the more calcidiol the liver makes. So, in the natural state, what limits the amount of cholecalciferol in the blood? What is the rate-limiting step for the production of calcitriol in the tissues?

Your skin! How much you go into the sun. Remember, the body has a fool-proof method of limiting cholecalciferol. Only about 20,000 units can be made in the skin every day because the same sunlight that makes it, begins to break it down. After your skin turns dark (tans) even less cholecalciferol is made, maybe 10,000 units. Humans have a natural system in the skin that prevents toxicity. Another way of saying this is that the rate-limiting step for the production of calcitriol in the tissues is your behavior: how often you go into the sun or how much cholecalciferol you take as a supplement. This makes vitamin D unique.

Block the Sun, Block Vitamin D

Remember, our ancestors lived naked in the sun for several million years. Then 50,000 years ago, some of us migrated north and south to places with less sun. Then we put on clothes, started working inside and living in cities where buildings blocked the sun. Then we started traveling in cars instead of walking, or riding horses, and glass blocked even more of the UVB in the sunlight. Then, only a few years ago, we started actively avoiding the sun and putting on sunblock. All this time we humans have been steadily reducing the tissue levels of the most potent steroid hormone in our bodies, one with powerful anti-cancer properties.

The really significant reductions in sunlight exposure have occurred since the industrial revolution, just the time the "diseases of civilization" like cardiovascular disease, diabetes, and cancer seem to have greatly increased.

Understanding Vitamin D Cholecalciferol

Caucasian skin produces approximately 10,000 IU vitamin D in response to 20–30 minutes summer sun exposure. This is over 16 times higher than the US government's recommendation of 600 IU per day!

This high rate of natural production of vitamin D3 cholecalciferol (pronounced koh·luh·kal·sif·uh·rawl) in the skin is the single most important fact every person should know about vitamin D—a fact that has profound implications for the natural human condition.

Technically not a "vitamin," vitamin D is in a class by itself. Its metabolic product, calcitriol, is actually a secosteroid hormone that is the key that unlocks binding sites on the human genome. The human genome contains more than 2,700 binding sites for calcitriol; those binding sites are near genes involved in virtually every known major disease of humans.

Current research has implicated vitamin D deficiency as a major factor in the pathology of at least 17 varieties of cancer as well as heart disease, stroke, hypertension, autoimmune diseases, diabetes, depression, chronic pain, osteoarthritis, osteoporosis, muscle weakness, muscle wasting, birth defects, periodontal disease, and more.

Vitamin D's influence on key biological functions vital to one's health and well-being mandates that vitamin D no longer be ignored by the health care industry nor by individuals striving to achieve and maintain a greater state of health.

If well adults and adolescents regularly avoid sunlight exposure, research indicates a necessity to supplement with at least 5,000 units (IU) of vitamin D daily. To obtain this amount from milk one would need to consume 50 glasses. With a multivitamin more than 10 tablets would be necessary. Neither is advisable.

How To Get Enough Vitamin D

There are 3 ways for adults to ensure adequate levels of vitamin D:

• Regularly receive midday sun exposure in the late spring, summer, and early fall, exposing as much of the skin as possible for 20–30 minutes (being careful to never burn). (Those with dark skin will need longer exposure time — up to six times longer.)
• Regularly use a sun bed (avoiding sunburn) during the colder months.
• Take 5,000 IU per day for 2–3 months, then obtain a 25-hydroxyvitamin D test. Adjust your dosage so that blood levels are between 50–80 ng/mL (or 125–200 nM/L) year-round.

Vitamin D's Co-factors

Vitamin D has co-factors that the body needs in order to utilize vitamin D properly. They are:

• Magnesium
• Zinc
• Vitamin K2
• Boron
• A tiny amount of vitamin A

Magnesium is the most important of these co-factors. In fact, it is common for rising vitamin D levels to exacerbate an underlying magnesium deficiency. If one is having problems supplementing with vitamin D, a magnesium deficiency could be the reason why.

There Is lncreaslng awareness of the biological actions of vitamin D (Holick 20(7). The diversity of effects Is remarkable but has not yet been fully placed in an evolutionary context. However, this process has begun with lndlcations that lighter skin color evolved to 0ptimize vltamln D production. Vitamin D defidency, with resulting rickets·induced pelvic contraction, which Is potentially 1eth.a1 for the maternal-fetal unit, likely has exerted major selective pressures Oablonskl and Chaplin 2000).

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OXFORD, England—Scientists have linked vitamin D to genes related to many diseases, including rheumatoid arthritis and cancer. Results of their genome study are published online ahead of print on Aug. 24 in Genome Research. The study was a collaboration of British and Canadian Universities, led by Oxford University.

The researchers mapped the molecular interactions of the vitamin D receptor (VDR) across the genome, finding numerous locations where VDR binding influences genes involved in various diseases. They used the ChIP-seq technique to isolate fragments of genomic DNA bound to the VDR before and after treatment of cells with calcitriol, the active form of vitamin D; they then sequenced the DNA fragments and identified more than 2,700 sites of VDR binding, including regions associated with autoimmune diseases such as multiple sclerosis, type 1 diabetes and Crohn's disease, as well as genome sites linked to cancers such as leukemia and colorectal cancer. Their investigation revealed a novel role for vitamin D at several disease genes, a discovery that should drive future research. They even found VDR binding locations involved in tanning, height and hair color.

Lead study author Sreeram Ramagopalan, Ph.D., of the Wellcome Trust Centre for Human Genetics at Oxford University said this research shows just how important vitamin D is to humans and the wide variety of biological pathways in which vitamin D plays a role. He noted the findings support the hypothesis that vitamin D interacts with genes in the pathogenesis of these diseases and punctuates the serious risks of vitamin D deficiency, especially for individuals who may be genetically predisposed to be sensitive to insufficiency. "Considerations of vitamin D supplementation as a preventative measure for these diseases are strongly warranted," he said.

There is a growing awareness that vitamin D sufficiency is required for optimal health. The role of vitamin D in calcium absorption and metabolism for bone health is well known. Research during the past two decades has illustrated the importance of vitamin D in reducing the risk of cancer, multiple sclerosis, and type 1 diabetes mellitus. A number of reviews on the role of vitamin D and prevention of disease and maintenance of optimal health have appeared in the past 2-3 years, and several recent conferences have been devoted solely to exploring the role of vitamin D in health and disease prevention. Finally, organizations in Australia and New Zealand have recognized a sufficiently high prevalence of vitamin D deficiency, even in these sunny lands, to have issued guidelines for solar UVB irradiation.

 

This article discusses the importance of vitamin D sufficiency at various stages of life as a guide to health practitioners, policy makers, and interested individuals.

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Posted By Dr. Mercola | February 23 2002

Before considering supplementation with vitamin D, it would be wise to have your vitamin D level tested. This is best done from a nutritionally oriented physician. It is very important that they order the correct test. The advantage of having your medical doctor perform the test is that it will usually be covered by your medical insurance.

Don't Be Fooled -- Order the Correct Test

There are two vitamin D tests -- 1,25(OH)D and 25(OH)D.

25(OH)D is the better marker of overall D status. It is this marker that is most strongly associated with overall health.

The correct test is 25(OH)D, also called 25-hydroxyvitamin D

Please note the difference between normal and optimal. You don't want to be average here; you want to be optimally healthy.

Primitive man likely developed in tropical and sub-tropical conditions with large exposure to UV-B and its secondary consequence to skin exposure, vitamin D.

Primitive environmental availability of a nutrient does not necessarily establish the higher requirements, but these exposures would have influenced the evolution of the relevant physiology, and such concentrations should at least be considered presumptively acceptable.

Some experts may disagree with the following healthy ranges, but they are taken from healthy people in tropical or subtropical parts of the world, where they are receiving healthy sun exposures. It seems more than reasonable to assume that these values are in fact reflective of an optimal human requirement.

(Holick MF. Calcium and Vitamin D. Diagnostics and Therapeutics. Clin Lab Med. 2000 Sep;20(3):569-90)

 

If you have the above test performed, please recognize that many commercial labs are using the older, dated reference ranges. The above values are the most recent ones based on large-scale clinical research findings.

Make Sure Your Lab Uses the Correct Assay

There are a number of different companies that have FDA approval to perform vitamin D testing, but the gold standard is DiaSorin. Their radioimmunoassay (RIA) method for measuring total vitamin D levels has become the gold standard, not because it's more accurate than the others, but because it's the one used in almost every major vitamin D study, on which the recommended blood levels for clinical efficacy are based.

Therefore, in order for any other testing method to offer clinically relevant results, the test values must agree with DiaSorin RIA results, since those were used to establish the recommended levels.

Vitamin D status is measured by looking at blood levels of 25-hydroxyvitamin D3. There are three common methods used for measuring vitamin D3:

LC-MS/MS – This test measures 25-hydroxyvitamin D2 and D3 separately RIA (DiaSorin) -- Developed in 1985, it accurately measures total 25-hydroxyvitamin D (It does not separate D2 and D3) Liaison (DiaSorin) -- a more recently developed automated immunoassay by DiaSorin that has largely replaced the RIA The LC-MS/MS (liquid chromotatography-mass spectrometry) method is the preferred method for many labs, including the Mayo Clinic, Esoterix, ZRT, and others, while Liaison is favored by other testing labs like LabCorp.

Recent developments in 2008 have made it clear that there are irregularities in the values obtained from the different testing methods. Although results from any of the three assays may be analytically accurate, they might not be clinically accurate, which is, ultimately, what matters.

Since the DiaSorin assay (RIA) was used in the major clinical studies that led to the recommended vitamin D levels, any lab using the LC-MS/MS method need to make sure their test correlate with the RIA test values in order to accurately determine your vitamin D status.

Tt's imperative that you find out if your lab has performed the appropriate recalibrations against DiaSorin's assays. Otherwise your vitamin D levels may be vastly overstated, in some cases by as much as 40 percent, meaning you may get the green light that your levels are fine, when in fact you are deficient, or perhaps even dangerously low.

How to Dose Your Vitamin D Once You Know Your Levels

Vitamin D is a fat soluble vitamin and can be quite toxic. Once you have vitamin D toxicity you can't easily turn it around, which is why I always recommend getting your levels checked prior to taking oral vitamin D supplements.

Overdosing on vitamin D from sun exposure however, is highly unlikely as your body has a built-in "failsafe" feedback loop, which will tend to shut down production when your levels are healthy. This is why I discuss getting optimal sun exposure, as opposed to lots of sun exposure. You know you've had enough once your skin turns the lightest shade of pink. Beyond that you're only increasing your risk of getting burned, which can cause skin damage.

So, be very careful when using oral vitamin D therapy and make certain you have your blood levels checked. Many of you may choose to ignore this warning, but I am telling you in no uncertain terms, that while vitamin D has enormous potential for improving your health, it has significant potential to worsen it, if you use it improperly.

For safety purposes it is advisable to optimize your vitamin D levels only with the help of a trained health care professional..

Sunlight Is Your Ideal Source of Vitamin D

Ideally, the best place to get vitamin D is from your skin being exposed to the UV-B that is in normal sunlight. Vitamin D from sunlight acts as a pro-hormone, rapidly converting into 25-hydroxyvitamin D, or vitamin D3.

Unfortunately, the amount of sun reaching most of the U.S. is only sufficient to generate a healthy vitamin D response for far less than half the year.

Most people don't live far enough south or high enough in the mountains to allow enough Ultraviolet (UV) -B to reach their skin. So, for those times of the year when access to the proper amount of sun is not possible, you will want to consider an oral form of vitamin D3 (cholecalciferol).

Ultraviolet-B Is What Generates Vitamin D in Your Skin

UV light is divided into three bands, or wavelength ranges, which are referred to as UV-A, UV-B and UV-C.

UV-B is sometimes called the "burning ray." It's the primary cause of sunburn caused by overexposure to sunlight. However, UV-B sunlight also produces vitamin D in your skin. The amount produced depends on exposure time, latitude and altitude of location, season, amount of skin surface exposed, and skin pigmentation.

UV-B also stimulates the production of MSH, an important hormone in weight loss, energy production, and in giving you that wonderful tanned appearance.

However, UV-B does not penetrate very deeply into your skin. The darker the pigmentation or more tanned your skin, the less UV-B penetrates. Other things that influence UV-B penetration include window glass and use of sunblock. Window glass allows only 5 percent of the UV-B light range that produces vitamin D to get through your home or car. Sunblock can block UV-B penetration drastically or entirely.

The timing of your sun exposure is also a major factor. Sun exposure must take place when UV-B is present. The actual dosing of your sun exposure is quite complex, since it involves knowing the amount of UV-B present, and is dependent on your skin color.

The amount of UV-B is not a constant. It is a major variable and is influenced by a number of factors:

• Latitude -- the further north you are the less UV-B there is
• Time of Year -- virtually none available in winter in continental U.S.
• Clouds -- can block UV-B
• Pollution -- smog and ozone can block UV-B
• Altitude -- the higher up you are, the more UV-B reaches you
• Person's age – elderly have substantially less efficiency at producing vitamin D
• Skin pigmentation – darker skin takes longer to acquire UVB to produce vitamin D

It is important to know your level of UV-B exposure. Unlike the typical American strategy "more is better," that is not the case for UV-B exposure. Longer exposure will not increase vitamin D production, but will increase the danger of skin damage and possible skin cancer.

Major Caution: Avoid Sunburn

It is important to stress that you should never get burned and should only implement sun exposure very gradually. While we all benefit from regular exposure to the sun, it is important to recognize that you should always limit your exposure so that you avoid getting burnt. Sunburn has been clearly related to an increased risk of skin cancer.

Interestingly, if you avoid getting sunburned yet have regular sun exposure, you will have a decreased risk of the dangerous form of skin cancer, melanoma. Optimizing your sun exposure in this way also reduces your risk of 16 other common cancers!

However, dermatologists will seek to frighten you about sun exposure. Please remember that we were all designed to have regular sun exposure. It is very similar to water. Just because you can drown while swimming, doesn't mean you should never drink water or swim in it. Similarly, as long as you avoid sun exposure that will cause burning, it will help improve your health.

It is a complex issue though. Skin cancer is largely related to the over-abundance of omega-6 oils consumed in the U.S. When sunlight hits these fats it can convert them to cancer-causing molecules, and if you are not healthy, cancer can develop. I recommend reviewing the following article for more information:

Does Too Much Sun Really Cause Melanoma?

This cancerous transformation doesn't happen with omega-3 fats. So, changing the ratio of omega-3 to omega-6 oils in your diet is one the keys to prevent this. The best source of omega-3 fat is krill oil.

Remember: Sunburn Has NO Health Benefits

It is also important to point out the obvious. Fair skinned individuals need far less exposure to receive their dose of sun to produce vitamin D. Lighter skin allows for greater penetration of UV-B, leading to higher levels of vitamin D.

African Americans however, need considerably more sun to generate vitamin D. This is one of the reasons why breast- and prostate cancer rates are so much higher in Africans who live in temperate climates. They just aren't able to get enough sun to generate vitamin D. In fact, in the Northern U.S. cities, they will find it impossible to get adequate vitamin D from sunlight in any season.

Elderly individuals will also have a great difficulty getting enough vitamin D from sun exposure, because an enzyme in their skin decreases with degenerative aging and, as a result, their skin has a limited capacity for producing vitamin D.

As I said earlier, it is impossible to get vitamin D toxicity from too much sun exposure. Your body just won't let it happen. That is why receiving your vitamin D from the sun is the best option whenever possible.

Remember, ultraviolet exposure beyond the minimal dose required to produce skin redness, does not increase your vitamin D production any further.

An equilibrium occurs in white skin within 20 min of ultraviolet exposure, at which point further increases in vitamin D is not possible, because the ultraviolet light will actually start to degrade the vitamin D.

It can take 3-6 times longer for darker pigmented skin to reach the equilibrium concentration of skin pre vitamin D. However, skin pigmentation does not affect the amount of vitamin D that can be obtained through sunshine exposure.

A common misconception is that occasional exposure of your face and hands to sunlight is "sufficient" for vitamin D nutrition. Indeed, this exposure can provide 200-400 IU vitamin D during those months when appropriate sunlight is available, but for most of us this is an absolutely inadequate exposure to move vitamin levels to the healthy range of 45-50 ng/ml.

What to Do in the Winter

Ideally it would be best to relocate during the winter to a subtropical location where you will have access to plentiful solar radiation. In the U.S. this would mean Florida, California, and Hawaii. Interestingly, Hawaii has the top longevity rate in the U.S. Residents of the state live, on average, more than five years longer than those on the mainland.

Realistically not many will be able to relocate during the winter months. An alternative would be to frequent tanning salons that use safe equipment. We have identified a database of them for your review.

For the ultimate convenience though, you can use a safe home tanning bed like the Sun Splash.

If relocating in the winter or using tanning beds does not appeal to you, then you will want to consider an oral form of vitamin D.

It is important to know that if you have sub-tropical or summer sun exposure on your skin it will be wise to avoid any oral vitamin D supplementation unless you regularly monitor your vitamin D blood level. However the vast majority of people in the U.S. cannot possibly receive enough UV-B to generate optimal levels of vitamin D from September to mid-April.

Please also remember that just because it is sunny and hot outside, it is absolutely not an indication of the amount of UV-B l present. If your latitude is above 30 degrees north or below 30 degrees south, you will likely benefit from vitamin D supplementation from September to mid-April.

If you don't know the latitude of your city you can use a latitude finder. If your latitude is lower than 30 degrees, then you have access to good sunshine and may not need oral vitamin D supplementation.

Please remember that it is best to have your levels regularly checked as supplemental vitamin D in certain clinical settings can be toxic.

Vitamin D Toxicity

First, let me state that there are two types of vitamin D supplements: vitamin D3 (cholecalciferol), which comes from fish oil, and plant source D2 (ergocalciferol), which is found in fortified foods and some supplements. D2, found in plants and made active by irradiation, is less biologically active.

Vitamin D3 is found in eggs, organ meats, animal fat, cod liver oil, and fish. It is the equivalent to the vitamin D3 formed on your skin from UV-B. You should stay away from the synthetic D2 as it has been shown to be toxic at the higher dose ranges.

You will only want to use vitamin D3 (cholecalciferol).

There are additional reasons why vitamin D2 has a greater potential for harm. First, vitamin D binding protein has a weaker affinity for the vitamin D2 metabolites than vitamin D3. Second, unique, biologically active metabolites are produced in your body from vitamin D2, but there are no analogous metabolites derived from vitamin D3.

There is no doubt that vitamin D2 is a synthetic analogue of vitamin D, with different characteristics. But it is inappropriate to regard vitamin D2 as a vitamin. Future research into the toxicity of vitamin D needs to focus on vitamin D3 as being something distinct from vitamin D2, for which almost all our current toxicity data relate to.

People Who Should Avoid Vitamin D

If you have sarcoidosis, tuberculosis, or lymphoma, it would be best for you to avoid oral vitamin D supplementation based on this test. It is recommended that you perform the 1,25(OH)D test before you supplement with any sun exposure or oral vitamin D as it is a better indicator in people with this health challenge.

Posted in News, Children’s Health, Industry News, Vitamin D, Women's Health

AURORA, Colo.– Seven out of every ten pregnant women in the United States are not getting enough vitamin D, according to a study published in the May issue of the American Journal of Obstetrics and Gynecology. A press release from the University of Colorado Denver School of Medicine, researchers noted the study found prenatal vitamins raise vitamin D levels during pregnancy, but higher doses may be needed for many women.

This research was supported by the National Institutes of Health. The study team from University of Colorado School of Medicine, Massachusetts General Hospital and Children’s Hospital Boston analyzed nationally representative data from 928 pregnant and 5,173 non-pregnant women of childbearing age collected by the Centers for Disease Control and Prevention.

The study showed many pregnant women in the United States have insufficient vitamin D levels. For those women, prenatal vitamins do not provide enough vitamin D and higher doses are needed to raise levels. Women with darker skin, those who cover their skin for religious or cultural reasons, and those living farther north during winter months are at particularly high risk for lower vitamin D levels, according to the university.

“Prenatal vitamins do help raise vitamin D levels, but many women start taking them after becoming pregnant,” said Adit Ginde, MD, MPH, assistant professor at University of Colorado Denver School of Medicine and lead author of the study. “Although research is ongoing, I think it’s best for women to start a few months before becoming pregnant to maximize the likely health benefits.”

Ginde added, “We already know vitamin D is important for bone health of the mother and infant, but we are just starting to scratch the surface about the many potential health benefits of vitamin D during pregnancy.”

Vitamin D deficiency early in life has been linked to increased risk of childhood wheezing and respiratory infections. Lower levels in adults have been linked to cardiovascular disease and cancer.

The study found some women have enough Vitamin D, and Ginde cautioned against excessive vitamin D intake. “We need more data from clinical trials of vitamin D supplementation in pregnant women. If the ongoing trials continue to show benefit, the best strategy will likely be measuring vitamin D levels through a simple blood test and choosing supplementation doses according to those levels. This tailored approach is common in preventive care for people with high cholesterol, and safer and more effective than a one-size-fits-all solution.”

Sources: * University of Colorado Denver: Many pregnant women not getting enough Vitamin D

Vitamin D is Strongly Associated with Reduction in Heart Disease Risk

March 26, 2009

Reference:  American Heart Association Meetings  March 15, 2010

The Newsletter is back.  I have had some issues at work as to whether I owned my own intellectual property.  I do.  And I may continue to email my friends.  Here we go again!  Let me know if you want to be off this list.  Otherwise,  almost every week……

I have to start with Vitamin D.  The momentum is growing. If you haven’t started taking D yet, this week should push you over the edge.  The large, widely publicized and authoritative medical journals are starting to carry stories about Vitamin D that demonstrate it’s utility.

The evidence is growing about how D works at the cellular level.  Each and every cell needs it to turn on the genes that make that particular cell into a mature cell.  Heart disease is really a disease of the “endothelium” or lining of blood vessels.  We know that the endothelium is an incredibly biologically active interface between the blood and the muscle lining of the arteries.  Vit D cools off the portfolio of genes that boost up inflammation.  And inflammation is the core dysfunction that sets off the cascade of damage.  Current state of the art theory argues that metabolic syndrome results from that inflammation, and from metabolic syndrome comes hypertension and diabetes.  When we treat hypertension and diabetes, we are jumping on the haywagon when the horse is already out of the barn.  It’s inflammation we need to be treating.  So, Vitamin D is one of the foundational strategies for preventing heart disease at its source, the inflamed and dysfunctional artery lining where plaque is growing and arteries are narrowing.  So, what’s the newest research?

From Utah, Dr. Brent Muhlestein, (Intermountain Medical Center) followed 31,000 patients over one year and found those with the lowest vitamin D levels had a 170-per-cent greater risk of heart attacks than those with the highest levels. Those with the lowest vitamin D levels also had an 80-per-cent greater risk of death, a 54-per-cent higher risk of diabetes, a 40-per-cent higher risk of coronary artery disease, a 72-per-cent higher risk of kidney failure and a 26-per-cent higher risk of depression.   Which of those would you like to choose?  It gets better!

Dr. Muhlestein took 9,400 patients from that group and gave them vitamin D, finding a 30% reduced risk of death in just one year.  Just one year!   If a drug company did this, the ads would be on every night on TV from 5 pm till midnight. 

He did not think it was ethical to withhold vitamin D in a placebo control group, in order to do a randomized controlled trial.  And that is also huge.  We have now reached the point where established researchers are stating that it is not ethical to withhold treatment from those who are deficient.  That means that letting someone remain at a low blood level is unethical. 

So, here is the formula that I have found that will get you to a healthy blood level.  First of all, if you have not been taking any, your blood level, now at the end of winter is likely less than 20 ng and possibly below 10 ng.  (Mine was 9 when I started 6 years ago).  Your fat tissue soaks up D like a sink so you need a loading dose to get started.  Most folks need about 300,000 IU over a month to get a good loading dose.  That’s 10 K a day for a month.  A single 100,000 IU dose will raise your blood level 15 ng and there is medical literature to show that will raise your blood level about 15 ng in a day or two.  It is safe and not toxic to the vast majority of folks.  (A few tiny number of people will be extremely sensitive – apparently folks with sarcoid are quite sensitive.)  Then, 5,000 IU a day for the rest of your life will get the majority of people to a blood level of about 60 ng .  So, you can get there in about a month.  If you just start on 5K a day, it will take you a year to get up to 60 ng.  So, do a loading dose.

Where can you buy it for cheap?  Sam’s Club has 5K capsules, 400 for $ 10.

WWW: What will work for me.  I’m taking 10 K a day and that has my blood level around 60.  I don’t need to measure it any more.  If I miss a day, I double up the day after.  You can take it once a week if you want.  And yes, I give it to my dog too.  We are all more cheerful!