Hi All !
As the author observed toward the end of this highly interesting and
entertaining newsletter: " .. it's the seminal discovery about vitamin
D. .. " - but read on dear reader, read on. Take note of comments
regarding safe upper limits; cod liver oil (avoidance thereof, due to
Vitamin A competition with VDR); high level prevention of a host of
maladies (including prostate cancer, MS, periodontal disease and
psychiatric illness); and last and perhaps most controversial of all
the link between profound vitamin D deficiency and race. In the USA
this link applies to Black Americans, but I would add the dark-skinned
diaspora from around the globe who have settled in the USA, as well as
Native Americans. Because of Globalisation, I'd put Europe into the
problematic equation faced by America. In some European countries
Moslems constitute 10% of the population, and Moslem women who cover
themselves from head to foot in our dark climates are particularly
vulnerable to vitamin D deficiency leading to birth defects including
fetal brain damage. Enjoy the read, and don't forget that every
reference made here is backed up by studies available on PubMeb, many
of them Free Full Text.
Sammy.
The Vitamin D Newsletter
May, 2006
This is a periodic newsletter from the Vitamin D Council, a non-profit
trying to end the epidemic of vitamin D deficiency. If you don't want
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newsletter as a PDF on the website.
This month we will start with a question from a reader in Chicago and
then see if the Vitamin D Conference just finished in Victoria,
British Columbia, answered any of his questions.
Dear Dr. Cannell:
I have been following the research on Vitamin D for several years now
- ever since I learned of the connection between vitamin D and
multiple sclerosis (my father died from that disease.) I have also
been receiving your very interesting newsletter and review the
Cholecalciferol Council website frequently. My training is in
physics, biochemistry, and anthropology from Stanford, and have
several publications in chemistry, pharmacology, and laser physics so
I appreciate the scientific updates. I am currently 42 years old. I
had a few questions for you which I was hoping you might be able to
address. I also wanted to give you some anecdotal evidence of my own
experience with vitamin D, for what that's worth. I understand
whatever reply you might give to me does not constitute "medical
advice," but just your opinion.
About a year ago, I started taking about 2000 units of cholecalciferol
a day (sometimes 4000 a day) - I noticed no significant differences in
my health either good or bad. This winter I received your update
about vitamin D and influenza. Not long after this, I came down with
the flu - a very bad case. I had read most of Heaney's articles on
Vitamin D, as well as Holick's and others', so I knew that the human
body can produce about 10,000 units a day in the summer sun in only
15-30 minutes, and had read all the statistics on Vitamin D overdose
and toxicity, so I figured that upping my intake to 10,000 units a day
for a few weeks might help me get over my terrible flu quicker, and
certainly couldn't hurt me. I did up my intake to that level (this
was about February 12th). It did not seem to speed up the recovery
from my cold. I was pretty sick for two-three weeks.
However, after the cold ended, I started to notice several good things
happening to my body. Things much improved. The first thing that I
noticed was that certain signs of inflammation that have been a
problem for me for many years went away. I have had major periodontal
disease for about 10 years, and nothing has helped very much. However
in about a month of taking 10,000 units a day of cholecalciferol, much
of my gum tissue healed significantly, stopped receding and became
significantly less painful. I was overjoyed! In addition to this, my
skin - which has often been red and inflamed (not psoriasis or
anything clinical, just very red) became much better - clear, smooth
and not red. The redness almost entirely disappeared! Five other
things improved noticeably as well. My sense of smell became, I would
estimate, 5 times as sensitive as it had been. I guess my sense of
smell was just average before - but now all of a sudden, I can smell
all kinds of subtle distinctions that I never could before. It is
EXTREMELY noticeable. In addition to this, my sense of balance
improved markedly and my guitar playing improved (I'm able to shift
cords faster). Additionally, I began to sleep much better. The
fourth thing I noticed was that my mood brightened noticeably - I was
just happier. Finally, (and this is a little embarrassing) my semen
quality and quantity went way up. Does vitamin D help semen?
As you can well imagine, I was overjoyed, feeling like I had found
some magic fountain of healing for many of my ailments. I felt like
an almost new person-the improvements to my life were NOT subtle!!
Then, my doctor told me 10,000 units a day was toxic. Immediately
after that, I started becoming nauseous every time I took vitamin D.
Could I be toxic?
Philip, Chicago.
Dear Philip:
If you are toxic from vitamin D, you are the first person in the world
to become toxic after taking 10,000 units a day for two months. That
said, you need to have a 25(OH)D and calcium blood test. I predict
your level will be about 80 ng/ml, well below the toxic range, and
your blood calcium to be normal. However, in my opinion, everyone
taking more than 2,000 units per day should have periodic 25(OH)D
levels until the government changes its Upper Limit. By the way,
unless you are fighting a life-threatening disease, there is just no
reason to regularly take more than 5,000 units a day, and then only in
the winter unless you assiduously avoid sunlight.
I'm not surprised that 10,000 units per day had no effect on the flu.
In my experience, one has to take 1,000 units per kilogram of body
weight for three days early in the course of the illness to have an
effect (that's 50,000 units a day for three days for a 110-pound
person, taken early in the course of the illness - just like
antivirals). As far as the other benefits you described, I have heard
them all, except for the improved sense of smell. You'll be
interested in what scientists reported in Victoria.
Victoria Conference
The Vitamin D Conference just finished in Victoria was nothing short
of spectacular. On the bus into Victoria, I met a representative from
the National Cancer Institute whose job was simple: her bosses at the
NIH wanted to know if they should fund the flood of grant requests
about vitamin D. Given the quality of the papers presented, I can't
imagine her answer was anything but yes.
Dr. Tony Norman and Dr. Roger Bouillon, the conference organizers, had
to choose from over 300 submissions from scientists around the world.
The venerable Dr. Bouillon did not try to back off his recent widely
quoted warning that more than a billion people in the world are
vitamin D deficient. Both men did a great job balancing presentations
on vitamin D nutrition, vitamin D basic science, and the patentable
vitamin D analogs sought by drug companies. Of course, I thought more
time should have been devoted to vitamin D nutrition but Dr. Norman
pointed out that more time was devoted to vitamin D nutrition than
ever before. Like Dr. Norman, I am unable to comment on all the
presentations that merited it, or this newsletter would be 50 pages long.
It was painful to hear the scientists use ten different names (and
interchangeably) for vitamin D, for 25-hydroxy-cholecalciferol, and
for 1,25- dihydroxy-cholecalciferol. Some even called ergocalciferol
vitamin D! Can you imagine scientists using the same name for
cholesterol, pregnenolone, testosterone, and estradiol? They do
exactly that with vitamin D. Editors of the major journals will not
accept reasonable names like "vitamin D" for cholecalciferol,
"calcidiol" for 25-hydroxy-cholecalciferol, and "calcitriol" for
1,25-dihydroxy-cholecalciferol. The presentations would have been
much smoother if scientists could get together and give vitamin D and
its metabolites common names like other steroid hormones.
Dr. Barbara Gilchrest, who fired Dr. Michael Holick from one of his
professorships several years ago after Holick wrote a book saying God
knew what she was doing when she created sunlight, gave the Plenary
Lecture. Wisely, Dr. Gilchrest overwhelmed the audience with graphic
pictures of invasive skin cancer to support her argument that sunlight
is evil. Of course, it's harder to show pictures of invasive colon
cancer, breast cancer, prostate cancer, and the 15 other internal
cancers caused by sunlight deprivation.
However, Dr. Gilchrest is changing her mind. George Bernard Shaw once
said, "Progress is impossible without change; and those who cannot
change their minds, cannot change anything." Dr. Gilchrest is
changing her mind - not about the evils of sunlight - about vitamin D.
She is in the process of admitting that this miraculous substance has
benefits beyond bone.
Two years ago, she dismissed any concerns about vitamin D with a "take
a multivitamin if you are concerned." Now she believes the Food and
Nutrition Board needs to consider raising both the Adequate Intake
recommendations (how much one should take every day) as well as the
Upper Level (the amount one can take on your own, without being under
a doctor's care, and without fear of toxicity). My compliments to Dr.
Gilchrest.
One of the most interesting things I learned in Victoria is that
scientists from England, Canada, New Zealand, Australia, and the rest
of the world, do not understand the "American Decade Rule." The rule
clearly states that if a U.S. scientist and a foreign scientist both
discover the same thing in the same decade, the American gets total
credit for it, even if the foreigner discovered it first.
Case in point: the discovery of the potent steroid hormone, activated
vitamin D or calcitriol, a discovery so important that it regularly
starts rumors of a Nobel Prize. Dr. Holick, Dr. Schnoes, and Dr.
DeLuca announced their discovery of calcitriol in April of 1971. A
group in England, led by Dr. Lawson and Williams, published the same
discovery in Nature, in March of 1971, a month earlier. Members of
the same English group, Dr. Fraser and Dr. Kodicek, discovered the
kidneys make calcitriol in November of 1970, a full six months
earlier. However, both English discoveries were within a decade of
the Americans. Therefore, the "American Decade Rule" applies and the
Americans get total credit. I was surprised that scientists from the
Commonwealth find the rule so hard to understand.
Proc Natl Acad Sci U S A. 1971 Apar(4):803-4.
Nature. 1971 Mar 26;230(5291):228-30.
Nature. 1970 Nov 21;228(5273):764-6.
Dr. Heike Bischoff-Ferrari did a wonderful job, not just presenting
her data that optimal vitamin D blood levels need to be at least 40
ng/ml, but for presenting Dr. Ed Giovannucci's data (who had to cancel
for personal reasons). Dr. Bischoff-Ferrari reminded us that
periodontal disease in inversely related to vitamin D blood levels.
She also reminded us that there is strong scientific evidence that
vitamin D improves neuromuscular performance in older people. She
didn't tackle the logical next question: will adequate levels of one
of the most potent steroid hormones in the body improve neuromuscular
performance in younger people, such as that need for optimal athletic
or musical performance? Philip, whose email to me is above, and other
readers of this newsletter have been telling me: yes, yes, yes.
Dr. Bischoff-Ferrari then presented Dr. Giovannucci's data that one
reduces your risk of all cancers about 17% for every 10 ng/ml of
vitamin D in your blood. For cancer of the digestive system, the risk
reduction is 43%. His data indicates all Americans should be taking
about 2,000 IU per day and some Americans need even more to minimize
cancer risk. No one know where the curve flattens out; that is, no
one knows how much further cancer reduction one gets from 20, 30, or
40 ng/ml incremental increases in blood levels.
The section on the enzymes that metabolize vitamin D reminded me how
much we don't know about vitamin D. Millions of Americans take
psychiatric and other medications that interfere with the same system
of enzymes (cytochrome P-450) that metabolize vitamin D. We've known
for a long time that some medications taken for epilepsy (Dilantin,
phenobarbital, Tegretol) reduce vitamin D blood levels. However,
which medications increase levels? I have seen a number of cases of
higher than expected levels in patients taking psychiatric medications
metabolized by cytochrome P-450 enzymes and some non-psychiatric
medications interfere with these same enzymes. This practical area of
clinical medicine needs more research.
Dr. Robert Heaney presented by video hookup and made his quiet but
powerful case that about 75% of American women are vitamin D deficient
(levels less than 35 ng/ml), that about 3,000 units a day are needed
to bring 95 % of the population out of the deficient range, and that
10,000 units a day is the safe upper limit. (This does not mean you
should take 10,000 units per day, it means scientists should be able
to study 10,000 unit daily doses without the bureaucratic difficulty
they now encounter).
Dr. Kimball, working with Dr. Reinhold Vieth, presented data that
children (age 10 -17) only increased their average blood level by 11
ng/ml when given 14,000 units per week for eight weeks and that such
dosing was safe. Dr. Vieth is also trying to fill another need in
vitamin D clinical science. We need a trial of healthy volunteers
taking 20,000 units per day for two or three years. Do blood levels
stabilize with oral dosing as they do with sun exposure? Does skin
production produce other vitamin D compounds, like dihydrotachysterol,
which inhibits the production of calcitriol and thus protects against
vitamin D toxicity? Do other vitamin D variants made in the skin
induce the metabolism of vitamin D, lower levels, and protect against
toxicity?
J Biol Chem. 1972 Dec 10;247(23):7528-32.
Does 20,000 units a day for years have any ill effects? Does it
affect blood or urine calcium? One study from the 1980's showed
10,000 units a day caused loss in bone density but they used a vitamin
D analog (ergocalciferol) which is a xenobiotic (generally foreign to
the human body). Therefore, we still don't know what 20,000 units of
real vitamin D (cholecalciferol) would do if given for several years.
Dr. Bruce Hollis presented data that reminded us of two overlooked
facts: (1) techniques to measure vitamin D in the blood have
significant reliability problems, and (2) vitamin D is the only
steroid hormone system in the body in which substrate starvation is
the rule. That is, only the vitamin D steroid hormone system is
chronically short of the substance needed (vitamin D) to fully
activate the system. Dr. Reinhold Vieth discussed the second fact in
his chapter in Feldman's most recent, and invaluable, textbook:
Vitamin D.
Dr. Hollis presented evidence in Victoria that levels of at least 40
ng/ml are required to normalize the enzyme kinetics of vitamin D.
[When I say vitamin D blood levels, I'm referring to 25(OH)D levels;
Bruce is studying actual vitamin D levels (cholecalciferol) as well as
25(OH)D levels]. Dr. Hollis continues giving pregnant and lactating
South Carolina women about 4,000 to 6,000 units a day in an ongoing
study. We predict easier pregnancies and less depression in the moms
- lower prenatal and perinatal mortality, fewer birth defects, fewer
infections, less diabetes, less psychiatric illness, less asthma,
stronger bones, and higher IQs in the children.
Dr. Paul Lips and Dr. Susan Whiting presented upsetting evidence that
vitamin D deficiency is the rule in most of the world; one exception
is the Scandinavian countries were vitamin D levels are the highest in
Europe, probably due to their cod liver oil. Unfortunately, hip
fractures in these same countries are the highest in Europe, probably
from the excessive vitamin A in cod liver oil. Stay away from cod
liver oil.
Osteoporos Int. 1992 Nov;2(6):298-302.
Dr. Hathcock did a great job reviewing the evidence that doses below
10,000 units per day have never been shown to be toxic and that
10,000, not 2,000, units per day should be the Upper Limit. He, like
so many others, urged the Food and Nutrition Board to revise their
outdated recommendations. Moreover, I understand from knowledgeable
people at the conference that the Food and Nutrition Board is planning
to do just that. Yes!!!!!!
Dr. Dixon presented fascinating evidence that high vitamin D blood
levels prevent sunburn! Of course, it makes sense. When vitamin D
levels are low, the skin stays as white as it can to make as much
vitamin D as it can, just in case you ignore Dr. Gilchrest's advice.
When vitamin D levels are high, the skin rapidly tans to prevent
excessive vitamin D skin production. A number of people have emailed
me that observation: now that their levels are high, they tan very
quickly. I've noticed the same thing.
Dr. Marie Demay presented her basic science research that vitamin D is
involved in hair follicles. I loved her talk although she's a
scientist and I'm a psychiatrist so I didn't understand much of what
she said. However, I've always thought that vitamin D will really
take off once science shows it's involved in any of three things: sex,
athletic performance, or hair growth. In Victoria, we saw evidence
for neuromuscular (athletic) performance and hair growth. Two out of
three isn't bad; great job, Dr. Demay! In the way of full disclosure,
my semi-baldness has not improved on vitamin D, but it has stopped
getting worse.
Dr. Cedric Garland recounted how, 26 years ago, he and his brother
Frank first thought about the relationship between vitamin D and colon
cancer. The brothers, together with colleague Ed Gorham, were the
first to provide epidemiological evidence that vitamin D deficiency is
involved in numerous cancers. Their seminal 1980 paper is going to be
reprinted, a well-deserved honor.
Int J Epidemiol. 1980 Sep;9(3):227-31.
Dr. Thadhani and his group from Harvard reviewed their recent
discovery that calcitriol and similar drugs increase survival in
patients with renal failure. He also presented evidence that renal
failure patients have profound deficiencies of both calcitriol and
vitamin D and their vitamin D deficiency is not corrected by giving
calcitriol or its analogs, which is the current practice.
Of course, Dr. Robert Modlin stole the show when he reported on his
research just published in Science that vitamin D may be, in effect, a
powerful antibiotic. For the first time, the UCLA group showed that
when researchers add vitamin D to African American blood, their blood
makes more of the natural antibiotics that humans rely on the fight
infection. Dr. Adrian Martineau, from the Imperial College in London,
followed Modlin and showed vitamin D helped fight tuberculosis,
probably from increasing these same natural antibiotics. Science has
discovered more than 200 of these naturally occurring antimicrobial
peptides; they are especially prevalent in the upper and lower
respiratory tract; at least one inactivates the influenza virus.
Let's not forget that two other groups have also recently shown the
antibiotic potential of vitamin D.
Science. 2006 Mar 24;311(5768):1770-3.
J Immunol. 2004 Sep 1;173(5):2909-12.
FASEB J. 2005 Jul;19(9):1067-77.
J Virol. 1986 Dec;60(3):1068-74.
Two hundred and sixteen papers were relegated to poster presentations
and all 216 of these scientists thought they should have been chosen
to present, as did I. Of course, that would have meant a month-long
conference. I only have space to mention of few of the most
interesting. Dr. Lu presented evidence that the vitamin D content of
fish is much less than previously thought, including mackerel. Salmon
is OK but the vitamin D almost disappears when the salmon is fried.
Dr. Kimball presented a case series of 12 patients with multiple
sclerosis who are now on 40,000 units vitamin D a day with an average
blood level of 180 ng/ml (the highest is about 400 ng/ml) and they
have no evidence of toxicity or calcium disturbances!!! (Don't do
this on your own; they have a very serious illness, doses were
gradually increased, and the patients are being monitored closely.)
Dr. Hardin, from Columbia University, presented evidence that blood
levels above 50 ng/ml should help patients with lupus. A group from
the University of Manchester presented the mechanism by which vitamin
D should reduce arteriosclerosis. A group from the University of
Chicago presented evidence that vitamin D should not only prevent
colon cancer, but help treat it as well. Dr. Robert Scragg of the
University of Auckland presented evidence that ethnic differences in
vitamin D levels explain a significant proportion of the reason
African Americans are more hypertensive than whites. The group from
San Diego presented evidence that vitamin D deficiency is intimately
involved in breast, colon, and ovarian cancer.
A group from the University of Manitoba presented evidence that
one-month-old infants tolerate 2,000 units of vitamin a day for three
months quite well without any evidence of adverse effects. A group
from Wake Forest University demonstrated that higher vitamin D levels
were associated with better neuromuscular (athletic) performance in
older Americans (should help younger Americans too). A group from the
University of Amsterdam showed that the increased risk of falling from
vitamin D deficiency is much worse in people with a common genetic
variation of the vitamin D receptor. Dr. Chen presented evidence that
plain old vitamin D should prevent prostate cancer.
Dr. Barsony, of Georgetown University, presented evidence that low
blood sodium is a risk factor for vitamin D deficiency and that such
deficiencies may not be able to be corrected until the low blood
sodium is corrected. Dr. Barsony really thought outside the box to
discover this potentially very important clinical finding. Dr. Godar
presented evidence that young Americans, not just older Americans, are
not getting much vitamin D from sunlight. Dr. Taylor showed evidence
that a significant number of young children have a previously
undetected form of vitamin D in their blood. (Sunlight triggers the
creation of a number of different versions of vitamin D in the skin,
that's why it's risky to avoid the sun and only depend on oral vitamin
D.) Dr. Patel and a group from the University of Manchester
announced evidence that vitamin D deficiency may be involved in
inflammatory polyarthritis.
Dr. Grant was involved in six presentations; the most interesting was
his replication of a 1937 finding that squamous cell skin cancer
reduces one's risk for a number of internal cancers. That's why I
used to be so happy when my dermatologist found a squamous cell cancer
on my skin. However, now that I maintain my level at about 60 ng/ml,
he hasn't been able to find any new ones.
Peller S, Stephenson CS. Skin irritation and cancer in the United
states Navy. Am J Med Sci: 1937;194:326-333.
Dr. Bulmer and his group from the Royal Victoria Infirmatory produced
evidence that vitamin D may play a role in allowing fertilized ova to
implant in the uterus and thus enhance fertility. Dr. Reichrath
presented evidence that transplant recipients are at a high risk for
vitamin D deficiency and that 50,000 units once a month may be the
most practical way of ensuring sufficiency. Dr. Selby from the
University of Manchester found the same problem in patients with
chronic pancreatitis. A group from the University of Tennessee found
the same problem in African Americans with heart failure. A group
from Norway confirmed that cancer patients do better if they are
diagnosed when vitamin D levels are the highest.
Finally, the Australian group headed by Dr. Darryl Eyles and Dr. John
McGrath continue to present their convincing evidence (confirmed at
this meeting by Dr. Abreu and a group from France) that profound
maternal vitamin D deficiency in mammals causes permanent brain damage
in their offspring. The racial implication of their work is
overwhelming because most of the women in the USA who are profoundly
deficient are African American. Are African Americans more likely to
be born brain damaged than whites? Would pennies worth of vitamin D
improve the disparate prenatal, perinatal, and postnatal outcome in
African Americans? The sad fact is that McGrath's and Eyles' work
will continue to be ignored because our society has no way to
rationally discuss, assimilate, or act on such racially charged
scientific discoveries.
So, Philip, to answer your question, I don't think you are vitamin D
toxic. Your physician just hasn't been keeping up with the
literature. When he told you that you might be toxic your mind took
over and caused the nausea - much like it does when you eat a
contaminated hamburger, get food poisoning, become violently ill, and
then become nauseous at the sight of a perfectly good hamburger for
the rest of your life. That's my psychiatric explanation (which makes
sense from an evolutionary viewpoint as well). Nevertheless, you
should ask your doctor for a 25(OH)D level.
As far as your semen question, you are really asking if a powerful
steroid hormone could have an effect on male ejaculation. Actually
two other men have reported the same thing to me in emails. If so,
it's the seminal discovery about vitamin D. Most men could care less
about vitamin D preventing cancer, heart disease, arthritis, or fetal
brain damage. However, if it increases the volume of their semen . . . .
John Cannell, MD
The Vitamin D Council
9100 San Gregorio Road
Atascadero, CA 93422
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