Vitamin D, Atherosclerosis, and Influenza
Before I answer reader's questions, I want to alert
readers to this month's groundbreaking study about
atherosclerosis and vitamin D. Atherosclerosis is
the disease process that leads to heart attacks and strokes.
Dr. Targher and his group in Italy measured the amount
of atherosclerotic plaque (carotid artery intimal thickness)
and the vitamin D levels of 390 diabetic patients.
The authors found low vitamin D blood levels were
an independent and strong predicator of atherosclerosis.
Professor Robert Scragg of the University of Auckland was
right 16 years ago, when he discovered that low vitamin D
levels are associated with heart attacks. Targher
G, et al. Serum 25-hydroxy vitamin
D3 concentrations and carotid artery intima-media
thickness among type 2 diabetic patients. Clin
Endocrinol (Oxf). 2006 Nov;65(5):593–597. Scragg
R, et al. Myocardial infarction is inversely
associated with plasma 25-hydroxy vitamin D3
levels: a community-based study. Int
J Epidemiol. 1990 Sep;19(3):559–63.
The flu season is just around the corner—I recommend
that you take enough vitamin D this winter to keep
your vitamin D level, also known as 25(OH)D, between
50–70 ng/ml.
For many people that means 5,000 IU per
day in the winter. If you do, our hypothesis predicts that
you will not be as likely to get viral respiratory infections,
and if you do get sick, it will not be as severe. The vitamin D
theory of influenza has two important strengths. It
is parsimonious, that is, it explains many observations
with a single mechanism. Most importantly, if our theory
is false, it can easily be disproved. Cannell
JJ, Vieth R, Umhau JC, Holick MF, Grant WB, Madronich S,
Garland CF, Giovannucci E. Epidemic influenza and
vitamin D. Epidemiol Infect. 2006 Dec;134(6):1129–40.
You can test the theory in another way. Simply obtain
a bottle of 50,000 IU capsules
of vitamin D3.
Wait until you are sure you are getting a cold or the flu.
Then take 1,000 IU of
vitamin D per pound of body weight every day for
three days. For a 150 pound adult, that would be 150,000 IU (three
capsules) a day for three days. This is called "stoss" therapy
in Europe and is safe to do, unless your have a high blood
calcium for any reason. Remember, bottles of 50,000 IU vitamin D
are a medicine, not a supplement, and you will make yourself
vitamin D toxic, and you may even die, if you take
a 50,000 IU capsule
every day for months or years.
Vitamin D and Obesity
Dr. Cannell: I
am a Seventh-Day Adventist missionary and work
in the poorest parts of West Oakland. I take 4,000 IU of
vitamin D every day and sit in the sun (arms and
face exposed) most days for fifteen minutes at noon.
It has cured my gum disease and I can run again full
blast after not being able to run a step for four years.
I have been handing out vitamin D
for two years as a first response to people with severe
auto-immune diseases. There's no blood testing,
no opportunity for quality medical care, no one to fall
back on in this third-world climate. I just educate
people as best I can about the advantages of vitamin D
and give them a bottle of Carlson's 2000 IU vitamin D
with instructions to take twenty to start and then two
a day for the rest of their life. The results have been
pretty spectacular, especially with people who have arthritis
or diabetes.
One unexpected result was that many
people are losing weight, twenty, thirty, forty pounds,
spontaneously, and they look great, too. One of these
individuals taking 4,000 asked me if vitamin D
made you lose weight. She is very obese but had rather
abruptly lost 20 pounds. Now, a month later, she has
lost a total of 32 pounds and is delighted. I can assure
you based on results here that many people who are obese
are most certainly losing weight on vitamin D.
One sad note is an individual who weighs
at least 300 pounds at 57. He's very strong and
hearty, a VA community-based psychiatric patient
with other health problems. I gave him a couple bottles
of vitamin D and he lost considerable weight, fifty
or sixty pounds. It didn't occur to me at the time
that the weight loss could be linked to the D, but I'm
almost certain that was the cause. Then he told his VA
doctor that he was taking vitamin D and the doctor
went nuts, told him it was toxic, and told him to never
take it—which is where things are today—and
he rapidly gained back all the weight. In my experience,
most doctors don't know anything about vitamin D
except that it's potentially toxic. Keep up your
good work! George Oakland,
California
I suspect that physiological doses of vitamin D
(5,000 IU per
day), will induce weight loss in obese vitamin D
deficient patients. I reviewed the reasons in a newsletter (PDF
format) several years ago. At this point, it would
be best if these patients had periodic vitamin D
blood levels, especially if they stay on these doses for
years. Another thing, in the summer, especially when you
sit in the sun, you should not take any oral vitamin D.
Yes, physicians know very little about the recent vitamin D
research and they won't until the lawsuits start.
Keep up your good work.
Sun Important For Children's Health
Dr. Cannell: I
have always been very protective of my children's
health. I made sure they ate right, went to bed on time,
and always wore sunblock. A few weeks ago, my 16 year
old computer whiz son decided to start jogging instead
of playing computer games all weekend. The very first
day he came home with his right foot hurting and the
doctor said the x-ray showed he had broken a bone
in his foot, a "stress fracture," from jogging!
He didn't step on anything or twist his ankle,
it just broke for no reason. The doctor told him he should
drink more milk but he drinks plenty of milk. What could
have caused this? April Duluth,
Minnesota
Your son had what I call a "Gilchrest fracture." About
30 years ago, dermatologists like Barbara Gilchrest at
Boston University, began telling Americans, including children,
to stay out of the sun, lather on the sunblock, and to "drink
milk" if they are concerned about vitamin D.
The problem is that your son would have to drink at least
40 glasses of milk a day to get enough vitamin D
if he followed her sun-avoidance advice and it sounds
like he did.
Gilchrest fractures are vitamin D
deficiency fractures in healthy people that occur
after normal activities. Two studies have clearly linked
such fractures to low vitamin D levels. A recent
Finnish study found Gilchrest fractures to be almost
four times more likely in young soldiers with vitamin D
levels below 30 ng/ml (75 nmol/L).
An earlier study of Israeli soldiers showed the same
thing. The surprising thing about both studies was none
of the men were obviously vitamin D deficient,
indicating—once again—that current lower
limits of vitamin D blood levels are set too low
and that serum 25(OH)D levels should be maintained at
50–70 ng/ml,
year around. Ruohola
JP, et al. Association between serum
25(OH)D concentrations and bone stress fractures in Finnish
young men. J Bone Miner Res. 2006 Sep;21(9):1483–8. Givon
U, et al. Stress fractures in the Israeli
defense forces from 1995 to 1996. Clin Orthop
Relat Res. 2000 Apr;(373):227–32.
The rates of Gilchrest fractures, even in young people,
have been steadily increasing over the last thirty years,
since dermatologists have been handing out their pathological
advice. For example, the incidence of fractured wrists
in American kids went up 32% in boys and 56% in
girls between the years 1970–2000. Khosla
S, et al. Incidence of childhood distal
forearm fractures over 30 years: a population-based
study. JAMA.
2003 Sep 17;290(11):1479–85.
A study in Great Britain showed a clear latitudinal variation
with the lowest fracture rates in sunnier southeast England
and the highest rates in of Gilchrest fractures in Northern
Ireland, Wales, and Scotland. Cooper
C, et al. Epidemiology of childhood fractures
in Britain: a study using the general practice research
database. J Bone Miner Res. 2004 Dec;19(12):1976–81.
The good news is that your son only suffered a broken
foot by following Professor Gilchrest's advice. As
you will see below, others have lost their lives.
Flu Shots
Dr. Cannell: I'm
75, and live at home. Should I get a flu shot? Most
of my friends get a flu shot. If I get a flu shot, will
it protect me from getting the flu? Susan
Washington, D.C.
Yes, you should and no, it does not. Although flu shots
don't prevent the flu in elderly people living in
the community, they do appear to reduce your risk of dying
or from being hospitalized. Jefferson
T, et al. Efficacy and effectiveness of
influenza vaccines in elderly people: a systematic
review. Lancet. 2005 Oct 1;366(9492):1165–74.
For ethical reasons, it is difficult to conduct a truly
random interventional study, that is, it is difficult to
take a large group of well-matched elderly people
and deny half of them a flu shot while giving the other
half a flu shot and then see who dies. Influenza-associated
deaths in the United States more than doubled between 1976–1999,
and 90% of those deaths were in patients 65 years
and older, a trend that can only be partially explained
by the aging population. If flu shots are effective, and
if more and more older Americans have been getting them,
why have more and more older American been dying of the
flu? Thompson
WW, et al. Mortality associated with influenza
and respiratory syncytial virus in the United States. JAMA.
2003;289:179–86.
One possibility is that flu shots do help, but vitamin D
deficiency promotes influenza more than flu shots
prevent it. And, as more and more older Americans follow
Dr. Gilchrest's advice to stay out of the sun,
more and more older Americans become vitamin D
deficient and then die from influenza, in spite of their
flu shot.
Sunlight Reduces Cancer
Dr. Cannell: My
mother died of breast cancer and my sister has had it
for two years. Now I have it. How much vitamin D
should I take? Shannon Boston,
Massachusetts
As I've said before, if I had cancer, I'd
take 5,000 IU of
vitamin D every day in the colder months. In the
warmer months, I'd stop the vitamin D and get
a safe amount of noontime sunshine. I'd keep my 25-hydroxy
vitamin D levels between 50–70 ng/ml,
year around. However, I do that now and I've not
been diagnosed with cancer. Several recent studies are
relevant to breast cancer. Dr. Carlo Palmieri, and his
group from the Imperial College in London, found that women
with early stage breast cancer had higher vitamin D
blood levels than women with more advanced cancers. Palmieri
C, et al. Serum 25 hydroxy vitamin D
levels in early and advanced breast cancer. J
Clin Pathol. 2006 Oct 17;
Even more important was the third study reported to date,
this time by Dr. Lim at the King's College in London,
showing improved survival when cancer is diagnosed in sunnier
months. Studies of season of diagnosis and cancer survival
are very important because they imply a treatment effect
from higher vitamin D blood levels. Lim
HS, et al. Cancer survival is dependent
on season of diagnosis and sunlight exposure. Int
J Cancer. 2006 Oct 1;119(7):1530–6.
In terms of sunlight and cancer incidence, a recent literature
review found 94 studies. The authors threw out 67 of the
papers for not meeting their strict criteria, although
every one of the discarded papers looking at the big three
(prostate
cancer, breast
cancer, and colon
cancer) showed sunlight reduces cancer. Of the remaining
27 papers, 8 of 8 prostate cancer papers, 7 of 7 breast
cancer papers, and 5 of 6 colon cancer papers showed sunlight
prevented cancer. The authors concluded, "There is
increasing and conclusive evidence that sunlight has a
preventative effect on the initiation and/or progression
of prostate and breast cancer, colon and possibly also
ovarian cancer." Someone needs to tell that to Professor
Gilchrest. van
der Rhee HJ, et al. Does sunlight prevent
cancer? A systematic review. Eur J Cancer.
2006 Sep;42(14):2222–32.
All this leaves us with a question, "Are physicians
responsible for their advice?" When dermatologists
or other physicians subvert the vitamin D steroid
hormone system by telling patients to avoid the sun, do
they assume an affirmative duty to assess and maintain
the vitamin D system they have subverted? Do
they have a duty to inform their patients about relevant
risks of sun-avoidance? Do they have a duty
to inform their patients about relevant risks of vitamin D
deficiency? How many dermatologists even bother
to check vitamin D levels in their pale-as-ghost
patients? How many bother to advise vitamin D
supplements? If they do advise supplements, how many
advise enough vitamin D to compensate for lack of
sunlight? These are questions for tort lawyers.
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