Vitamin D Shows Heart Benefits in Study
By RONI CARYN RABIN NYT Nov 16 2009
Henry’s notes Jan 3, 2009 of many of the comments
Many many interesting links, and the following quotes from the discussion forum
There are perhaps 200 different important metabolic processes that use vitamin D as a co-factor.”
It truly is the “wonder vitamin.”
leaves me just a bit skeptical
lab charged $230 for the test
beta-carotene or Vitamin E/selenium studies
I already have to take pills, so I’m always loathe to add
finger and toe nails grew slowly in the winter.
Dialysis patients need to take a special form of Vitamin D to provide a deficiency
excessive amounts may result in kidney damage due to excess circulating calcium levels. (See studies conducted in Israel among lifeguards)
Do vitamin D levels show up on the average annual blood work
Medicare only pays per patient for one Vitamin D level blood test ,every 5 years.
Vitamin D supplementation is the most important step anyone can do for his or her long-term health. Nothing else comes close.
Soy milk had D2, Organic milk often had no D added
Any 1st year intern who has bothered to read at least 2 or 3 articles in the last year will know that at least 50 ng/ml activated D in the serum is healthy.
see the doses you’d have to take to become toxic — you’d go broke in the vitamin aisle first!)
Matthew Staver for The New York Times Vitamin D lowered the risk of heart disease in a new study.
Vitamin D, of milk fame, is known for helping with calcium absorption and for building strong bones, which is why it’s routinely added to milk. But there is more and more evidence that vitamin D is a critical player in numerous other aspects of metabolism. A new study suggests many Americans aren’t getting anywhere nearly enough of the vitamin, and it may be affecting their heart health.
In the study, researchers looked at tens of thousands of healthy adults 50 and older whose vitamin D levels had been measured during routine checkups. A majority, they found, were deficient in the vitamin. About two-thirds had less vitamin D in their bloodstreams than the authors considered healthy, and many were extremely deficient.
Less than two years later, the researchers found, those who had extremely low levels of the vitamin were almost twice as likely to have died or suffered a stroke than those with adequate amounts. They also had more coronary artery disease and were twice as likely to have developed heart failure.
The findings, which are being presented today at an American Heart Association conference in Orlando, don’t prove that lack of vitamin D causes heart disease; they only suggest a link between the two. But cardiologists are starting to pay increasing attention because of what they’re learning about vitamin D’s roles in regulating blood pressure, inflammation and glucose control — all critical body processes in cardiovascular health.
Earlier experiments in mice that were genetically altered not to respond to vitamin D found that the animals developed high blood pressure and a heart condition called left ventricular hypertrophy. And population studies of humans found higher rates of coronary heart disease and hypertension the further people live from the equator. Vitamin D deficiency is rare in tropical settings because of the strong sunlight, which promotes creation of the vitamin in the skin.
“What we were taught in medical school about vitamin D is that it’s associated with rickets and calcium metabolism,” said Dr. Joseph B. Muhlestein, a researcher with Intermountain Medical Center in Murray, Utah, and one of the authors of the new study. “We cardiologists didn’t worry about it; and we certainly didn’t order vitamin D levels.”
That, however, is changing. “What’s been discovered in the last few years is a significantly greater role for vitamin D,” Dr. Muhlestein said. “There are perhaps 200 different important metabolic processes that use vitamin D as a co-factor.”
The study involved 27,686 patients at the Intermountain Medical Center based in Salt Lake City. Low tobacco and alcohol use rates in that patient population made it easier for researchers to focus on the effects of vitamin D on heart health.
Patients were divided into three groups based on their vitamin D levels: “normal,” for those who had over 30 nanograms per milliliter of blood, “low” for those with levels of 15 to 30, and “very low” for those with levels less than 15.
Those with the lowest vitamin D levels were 77 percent more likely to die during the follow-up, 78 percent more likely to have a stroke and 45 percent more likely to develop coronary artery disease than those with normal levels. They were twice as likely to develop heart failure as those with normal levels. And even those who had moderate deficiencies were at higher risk, the researchers said.
People who were vitamin D deficient were also twice as likely to have diabetes and tended to have more high blood pressure. But being vitamin D deficient was an independent risk factor for poor outcomes, regardless of other risk factors like diabetes, Dr. Muhlestein said.
The next step for researchers is to figure out whether vitamin D deficiency actually causes disease. It’s possible that people who already have an underlying illness spend more time indoors and aren’t exposed to the sun, where they can absorb vitamin D through the skin. It’s also possible that disease processes already under way may affect vitamin D levels.
A clinical trial that randomly assigns participants to take vitamin D supplements or a placebo might be the next step, Dr. Muhlestein said. Researchers at Harvard and Brigham and Women’s Hospital are starting a large trial in January that will test the effects of vitamin D and omega-3 fatty acid supplements on men and women in their 60s.
Dr. Thomas Wang, an associate professor of medicine at Harvard who published an earlier trial on vitamin D deficiency and heart disease, said that whether treating vitamin D deficiency will have a beneficial effect on heart health is still an open question.
“If that does turn out to be the case, it would have pretty profound public health implications,” he said. “Vitamin D deficiency is very common in this country and other developed countries in northern latitudes, where people don’t get much sunlight and spend most of their time indoors.”
Doctors warn that anyone concerned about vitamin D levels should check with a doctor and have blood tests run. Vitamin D supplements are inexpensive and sold over the counter, but excessive amounts of vitamin D can be toxic.
The Institute of Medicine recommends adults under 50 who aren’t getting vitamin D from the sun get 200 international units of vitamin D a day, and that those 50 to 70 get 400 I.U. a day. Elderly people need even more. There is some controversy, however, over optimal amounts. Many doctors are advising their patients to take much higher amounts, such as 1,000 I.U. a day. The American Academy of Pediatrics has already increased its recommendation for supplementing breastfeeding infants to 400 I.U. — vitamin D is one nutrient breast milk doesn’t provide enough of — and the Institute of Medicine will issue updated recommendations in May 2010.
Comments
1. Earlier comments on this Well blog indicated that vitamin D also protects against neurodegenerative diseases, such as ALS, MS, Parkinson’s, and Alzheimer’s. It truly is the “wonder vitamin.”
Question: is there any danger of getting too MUCH vitamin D? Is it a fat-soluble or water-soluble vitamin? There is a risk, for example, of getting too much vitamin A or calcium.
4. Canada has much higher recommendations for Vit D intake. See http://www.cps.ca/ENGLISH/statements/II/VitaminD.pdf for example. Pediatricians in Vancouver, just over the border, suggest 2000IU for children. I”m an apparently healthy 55 y.o. male in Seattle and need to take 6000 IU/day to get my blood level into the 40’s on the blood test (still low-ish).
6. People with dark skin living in the northern latitudes(like myself) need to pay particular attention to studies like this. From what I’ve read, living where we do, we would need to spend two hours, totally nude, in full sun in order to get enough vitamin D each day. Between this and the fact that so many of us can’t drink milk, we’ve gotta get on top of those vitamin D supplements.
7. Herring anyone?
As posters mentioned in the earlier Well “Phys Ed:” discussion, historical northern peoples all ate high fat diets from fish, fowl, and/or mammals, and survived sun-free (and anecdotally, type 2 diabetes and heart disease free) through those long dark winters.
If appropriate interventional studies are designed and implemented, I expect it will likely become clear that both sun avoidance and animal fat avoidance are bad ideas for most humans, consistent with our evolutionary history. I’m convinced vitamin D is very important, but it will also be interesting to tease out how much of the associations this study finds are because of the vitamin D vs. the other effects of sun exposure and diet on the human organism.
8. There has also been research linking low vitamin D levels with an increased risk of breast cancer. Amazing how one vitamin can effect so many different systems isn’t it.
Kate @ http://www.aftercancernowwhat.com
15. The current article is a great example of how things should be done. Document a correlation between heart disease and low vitamin D levels, but then follow it up by an intervention study asking whether taking vitamin D pills can prevent heart disease.
Correlations are simply not enough. Remember what happened with hormone replacement therapy(HRT) and breast cancer. Correlation studies showed that HRT was associated with less breast cancer, but when subjects took HRT, it actually caused breast cancer when compared to a placebo.
18. Many of these studies document associations rather than causations, or reflect results in laboratory preparations. There’s little, if any, harm to checking levels, and taking supplements carefully, ideally in the context of a good diet rather than substituting for one. The various reports are fascinating and well worth researching further. But the notion of a ‘wonder vitamin’ with key roles in every metabolic and pathological process from cancer to influenza to cardiovascular disease to Parkinson’s and Alzheimer’s, and the implication that a disease-free Utopia awaits its full exploitation, leaves me just a bit skeptical.
Calcium, which vitamin D has been long known to have a crucial role in, does indeed show up in various places. Calcium channels in heart tissue have long been a pharmacological target, for instance, in treating arrhythmias.
Vitamin D is indeed a fat soluble vitamin, so excessive ingestion of supplements can lead to toxicity.Less may well be not enough, but more after a certain point is too much.
19. ….. To read a summary of the current benefits of Vitamin D:
Everything You Ever Wanted to Know About Vitamin D from the Expert, Dr. Michael Holick. How Much Do We Need? Why Is It So Hard to Get Enough? What About Breast-Fed Babies? Why Is It So Important for Good Health?
==http://www.happyhealthylonglife.com/happy_healthy_long_life/2009/10/goodbye-sun.html==
21. My doctor ordered a vitamin D test for me at my last exam. The lab charged $230 for the test. I could have bought years worth of supplements for that.
25. November 16, 2009 1:39 pm Link
This is very important. I hope everyone pays attention and also helps their parents pay attention to these crucial matters - for heart issues as well as osteoporosis issues.
This article is an example of irresponsible science journalism.
The study reported is a weak study, rife with opportunity for confounding, and does not in any way prove causation. In fact, all of the evidence regarding vitamin D is weak and requires further research before any recommendations to be made. The authors clearly have a stake in promoting their own study, and their wild overstatements about the study’s importance and quality should have been questioned with better depth.
The recommendation in the study for people to see their doctors and have blood testing done is premature. It is still not known that vitamin D “deficiency” is a cause of any single illness, and also not known whether vitamin D supplementation does any good (aside from improving the metabolism of calcium, which has long been known).
There is a cyclical nature to the American vitamin obsession. Every few years, one vitamin becomes the vitamin-du-jour, is touted as the cure-all for every disease under the sun, and then when truly, rigorous scientific studies are carried out, the discovery is made that in fact supplementation of the vitamin in healthy people makes no difference (eg. vitamin C), or in some cases, does harm (eg. vitamin A).
There is no magic pill. Eat well, exercise, be happy, live well.
— VA, MD MPH
28. It doesn’t make sense from an evolutionary perspective that it would be so difficult to attain adequate levels of a vitamin that is supposedly so important for our health.
As a cardiologist, it reminds me of the whole homocysteinerigamarole from a few years ago: people with high homocysteine had higher cardiac event rates. We gave folate supplements to improve the homocysteine levels. And guess what– it didn’t make any difference!
— RA, MD
30. As a scientist I’m quite fascinated by vitamin D’s role in optimal health. The health benefits of vitamin D can not be overemphasized as the vitamin is so important to a number of life processes and disease prevention. Not only is vitamin D necessary for strong bones, but it deficiency of the vitamin has been linked to rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease, and type I diabetes. Few people may know this but vitamin D also plays a role in mood and appetite. In October 2008 I wrote an article “Are Your Children Getting Enough Vitamin D?” wherein I discussed the role that vitamin D plays in maintenance of optimum health. You can find the article here:
Fish oil contains essential fatty acids (EFAs) which play a role in reducing cardiovascular disease by improving circulation; it even boosts the body’s immune system. People tend to not consume enough fish which means that are deficient in omega 3 fatty acid which is found in fish such as mackerel, salmon and herring. If people added fish to their diet or took fish oil supplements it could go a long way toward improving health. You can read about the role of EFAs and their sources at my website.
I’m also looking forward to the results of the upcoming Harvard and Brigham and Women’s Hospital study on the relationship between EFAs and vitamin D as I would not surprise me to read that the researchers observe an added benefit of these nutrients working together improve the cardiovascular health of the test subjects.
33. Vitamin D deficiency is fat-soluble and correlated with obesity, making the causal connection between heart disease and diabetes with Vitamin D tricky. As others have pointed out, correlation does not equal causation and intervention trials need to be done.
I also find it odd that there is a vast wave of Vitamin D “deficiencies”. There is some disagreement on how much is enough, without a rigorous breakdown on what exactly the cutoffs mean. Given that we do not have a wave of rickets, we do not know if the current values are really any different from what has been seen in the past.
Given the potential for toxicity, these issues need to be addressed in a serious way before the majority of the American populace ends up on supplements. Past studies (liked the beta-carotene or Vitamin E/selenium studies)have shown that vitamins are not always as beneficial as they are touted to be and should not be universally recommended without the research to support it.
34. One has to be careful in interpreting what the AAP said about human milk and vitamin D. The statement did not say that human milk is deficient in vitamin D per se; rather, it states that if a breastfeeding woman is deficient in vitamin D her milk will be deficient in vitamin D and unless her infant receives either a supplement or sunlight exposure (which can be detrimental to the skin), the recipient infant will be deficient in vitamin D. In women who are replete in vitamin D, they have great levels in their milk. It makes no sense at all to think that we evolved if the majority of our species as we moved away from the equator was deficient in a major vitamin or in this case, hormone. The phenomenon is recent on the evolutionary scale. No one should be deficient in this vitamin/hormone and there are steps that can be implemented to correct the deficiency–in both mother and baby.
35. Association studies do not prove causation. Indiscriminate use of high-dose Vitamin D supplementation is imprudent and may be harmful. As others have pointed out, rigorous clinical trials are required to determine the risk/benefit ratio of Vitamin D supplementation. As prior studies have shown, for example, there is no benefit for routine supplementation of Vitamin C or Vitamin E. In fact, these may even be harmful. Prior studies of Vitamin D such as the Women’s Health Initiative showed no benefit from Vitamin D supplementation.
Clinical trials are vital in order to better understand the risks and benefits of Vitamin D supplementation. The effect of Vitamin D supplementation on risk factors for heart disease is being studied in a clinical trial at The Rockefeller University
==http://www.rucares.org/clinicalstudies/protocol.php?id=333==
==http://clinicaltrials.gov/ct2/show/NCT01008384==
— Manish Ponda, MD
38. November 16, 2009 3:55 pm Link
Some commenters have mentioned the possibility of Vitamin D toxicity assocated with overdose. While there is a theoretical risk, in the real world there are virtually no cases of Vitamin D toxicity reported in any given year.
44. I share the skepticism of others– I find it hard to believe that so many people could be deficientin a vitamin that is supposedly so important. And there is a cyclical nature to these vitamin crazes. I’m curious about the vitamin D profile of cultures that spend much more time outside.
I find it hard to believe that one could eat a healthy, well rounded diet including dairy and spend an hour outside exercising and still have a problem. I already have to take pills, so I’m always loathe to add
I am 65 years old. I started taking 1000 units a day of Vitamin D upwards of 3 years ago when the first positive reports started to appear. One thing unexpected did occur. When I was very young, my mother told me that finger and toe nails grew slowly in the winter.This, I observed, was demonstrably so. However, once I started taking the vitamin D tabs, my nails started to grow faster year round. I am sure that this incidental to the other observed effects but I found it interesting nevertheless. …..
53. Study showing superiority of D3 over D2: ==http://jcem.endojournals.org/cgi/content/full/89/11/5387==
Report on Vitamin D toxicity: “The weight of published evidence on toxicity shows that the lowest dose of vitamin D proven to cause hypercalcemia in some healthy adults is 1000 mcg (40,000 IU) per day of the vitamin D2 form” ==http://www.direct-ms.org/pdf/VitDVieth/Vieth%20CHAPTER%2061.pdf==
54.In most cases, processing of food does not lower the Vitamin D content. Instead processing increasing the vitamin D content - because it is added (fortified) . In the US milk is required to be fortified with vitamin D. Soymilk does not contain vitamin - it has to be added. Ditto for margarine. Natural food sources of vitamin D are liver (marine or land animals - remember cod liver oil!); egg yolks and fatty fish.
Skin does not absorb vtamin D. Skin produces Vitamin D when irradiated by UV light, Vitamin D needs to be activated in the body by two organs, liver and kidney. If either one is not healthy, vitamin D might not be functional in the body. Dialysis patients need to take a special form of Vitamin D to provide a deficiency.
56. November 17, 2009 1:06 am Link
Although it is difficult to get too much vitamin D, studies have shown that excessive amounts may result in kidney damage due to excess circulating calcium levels. (See studies conducted in Israel among lifeguards). As to the comments about dermatologists, one of the pioneering studies in vitamin D inadequacy and lower back pain was conducted in Saudi Arabia, where an astonishingly high percentage of the population was found to be vitamin D deficient due to covering the body head-to-toe with clothing to protect from the fierce sunshine.
— Dr. Carole Goldsmith
58. Does Vitamin D Make the World Go ‘Round’? Hollis and Wagner paper on vitamin D in breast feeding show 6400iu/daily enables human breast milk to flow replete with D3 at latitude 32N.
==http://www.liebertonline.com/doi/pdf/10.1089/bfm.2008.9984==
They also reported that 4000iu/daily at that latitude was sufficient to meet the mothers daily needs.
Further north it is likely more vitamin D is required.
A status of 55ng is associated with lowest incidence of chronic illness. Around 5000iu daily achieved that.
==http://www.grassrootshealth.net/media/download/disease_incidence_prev_chart_101608.pdf==
59. Do vitamin D levels show up on the average annual blood work my doctor does, or does it require a special test? Is it called something other than vitamin D, I don’t see it.
61. I have tested 1700 people for 25-hydroxyvitamin D since 2005 and so have been able to draw some conclusions, also backed by published research that has been done.
- 1, Shana, in order to get too much vitamin D by raising the blood level to over 150 nanograms, it would require a massive amount of vitamin D for many months. No human has ever gotten too high a level from the doses mentioned in these comments. Many lifeguards have levels of 150 ng. at the end of the summer.
- 4, Richard’s experience is not unusal, many people need 6000 Units a day or even more to reach and maintain an ideal level.
- 5, I have noticed that vitamin D levels in Southern New Jersey drop an average 15 ng. in the winter.
- 6. 2 hours of full sun exposure may or may not result in idea vitamin D levels. If a person lives north of the latttude of the state of Georgia, many months of the year outside of summer the sun isn’t strong enough to produce vitamin D.
RE the comment on $230 blood tests. I get my level, the retail charge is in fact close to that amount. My Horizon Blue Shield knocked down the price, approving only $45. Because of a high deductible, that is what I paid. Some other insurance companies, or if someone doesn’t have insurance that pays for it, actually would be billed for $230. There are organizations on the web offering tests for around $45. Most of my 1700 patients had their test completely paid for by the insurance company.
The doses mentioned in the article for adults (excluding the issue of pediatric vitamin D) simply don’t work well. 400 Units a day raises the level on average 5 nanograms. 10% of people have single digit values, many are in the teens and 20’s. .
And then, there are those 2 women out of 1700 people who walked 2 and 5 miles a day for years, every day, and had levels of 105 ng. They don’t need any supplements.
In view of it’s importance and osteoporosis, cancer, autoimmune diseases, and heart disease, benefit would mean getting a level, taking a dose for 6 months to aim for an ideal level, and repeat the level in 6 months. Most often people will find they have to increase the dose as their level has improved, but not high enough.
The appreciation that Vit. D insufficiency is pandemic is the one of the important discoveries in preventive medicine, and many billions of dollars in health care costs could be eliminated by the widespread correction of levels.
Robert Baker, MD Primary Care Internal Medicine Cherry Hill, NJ 08003
62. Careful, everyone. More harm than good is done when everyone jumps to take a vitamin supplement. Especially with fat-soluble vitamins, people should check with their doctor and get a specific dosage recommendation if they are indeed deficient. I can see people running to the drugstore now to take high doses of vitamin d resulting in an uptick in kidney failures. The best thing to do is adjust your diet. For those of us in North America, we have access to such a wide variety of food year-round that unless you eat an extreme diet we should all be getting plenty of the vitamins and minerals we need.
66. Strange though it may seem Medicare only pays per patient for one Vitamin D level blood test ,every 5 years. That being the case my Physician said on my blood test that i was low in my Vitamin.D levels but now after being on Vitamin D supplementation for a year she can not order another test to see if the supplements of Vitamin D3 I am taking are working.”Medicare wont pay for a follow up test”.
72. November 17, 2009 1:00 pm Link
Vitamin D supplementation is the most important step anyone can do for his or her long-term health. Nothing else comes close. The benefits are just being discovered and we have a long, long way to go. I am an amateur researcher of supplements and vitamins for 13 years. I have read thousands of studies and abstracts on practically everything. Last year I stopped looking at anything but vitamin D. It is absolutely the most misunderstood molecule on the planet. NOTHING is more important than raising and maintaining (for the rest of your life) a level of activated vitamin D (chloecalciferol) of at least 50 ng/ml. The FDA, NIH, AMA know almost nothing about this compound and fortunately there are researchers who have 40+ years of knowledge to share. I stress again it is absolutely the most important thing you will ever do. Vitamin D, a steroid, not a vitamin is the body’s most important disease fighter. It is incomparable to anything else man made combined. Get the facts at: The Vitamin D Council. And read everything you can find. Heart disease is almost completely a function of vitamin D deficiency over decades. As is cancer, diabetes, etc etc etc. Nothing matters in the end but 50 ng/ml.
— Charles S
73. In the last year, I have included summaries of the following Vitamin D into my newsletter:
Low 25-Hydroxyvitamin-D Levels Associated With Higher Prevalence of Peripheral Artery Disease
Arterioscler Thromb Vasc Biol. 2008;28
==http://www.medscape.com/viewarticle/573388?src=mpnews&spon=2&uac=22879SK==
Guidelines Needed for Optimal Vitamin D Supplementation in Cancer Patients
A growing amount of research suggests that vitamin D may be beneficial to cancer patients. In addition, laboratory, ecologic, and epidemiologic studies have shown some evidence that higher levels of vitamin D might lower the risk for colon, breast, endometrial, and prostate cancers.
J Clin Oncol. Published online before print April 6, 2009.
==http://www.medscape.com/viewarticle/591123?src=mpnews&spon=7&uac=22879SK==
Vitamin D Supplementation Benefits Dialysis Patients
National Kidney Foundation 2009 Spring Clinical Meetings: Abstract 209. Presented March 26, 2009.
==http://www.medscape.com/viewarticle/590464?src=mpnews&spon=34&uac=22879SK==
Vitamin D Insufficiency Linked to Asthma Severity, Am J Respir Crit Care Med. 2009;179:739-742, 765-771 ==http://www.medscape.com/viewarticle/702162?src=mpnews&spon=18&uac=22879SK==
Chronic Pain Linked to Low Vitamin D Pain Med. 2008;9:979-984. Abstract ==http://www.medscape.com/viewarticle/590151?src=mpnews&spon=26&uac=22879SK==
Vitamin-D Levels Inversely Correlated With Disability and Disease Progression in Multiple Sclerosis; The Consortium of Multiple SclerosisCenters (CMSC) 23rd Annual Meeting and 2nd joint meeting of the American Committee for Treatment and Research in MS (ACTRIMS): Abstract P07. Presented May 29, 2009, ==http://www.medscape.com/viewarticle/703670?src=mpnews&spon=26&uac=22879SK==
Adequate Vitamin D Levels May Aid Weight Loss in Obese Patients, ==http://www.medscape.com/viewarticle/704295?src=mpnews&spon=34&uac=22879SK==
Copies of the summaries (if you can’t get into the web site- for licensed health professionals only) can be sent on request; please state which study you are interested in to DrVittoriaRepett at aol.com
http://www.drvittoriarepetto.com
— DrVittoriaRepetto
74. Soy and other non-milk drinksare not a good source of D because almost all contain D2not D3. D2 is toxic. The milk industry used to add it to milk but quietly stopped the practice years ago.
77. Most of the organic milk brands do not add vitamin D. Check the labels if you are concerned.
If you go to the nihpubmed page for clinical trials ==http://clinicaltrials.gov/==and search for “vitamin d” you will get a list of 874 studies, or which 803 are interventional. If you refine your search for “trials with results” you get a list of only 7 studies, and none of these are long term interventional studies studying health outcomes. (However, there are a lot of interventional trials in progress.)
Since pre-supplementation vitamin d levels are strongly determined by lifestyle choices (outdoors vs indoors activities and related lifestyle activities) and diet (amount of vitamin d-rich natural fat products in fish, dairy and meat foods and related lifestyle attributes vs. e.g. high refined carbohydrate intake and related lifestyle attributes), it is a huge mistake at this point to attribute all the vitamin d associations to cause and effect from the vitamin d!
Interventional trials are the only way to more carefully sort out cause and effect.
80. I have a primary care doc in New England, where we don’t get much sunshine on our skins in the winter, who is a big believer in Vitamin D. I take 50,000 IU every 2 weeksand it’s much cheaper through the clinic’s pharmacy (about $10 for a year’s supply) than from the local drugstore. Some of his patients take 50,000 IU every week. The nice thing is you can take these big doses less often instead of daily doses.
91. This is a fascinating and important evaluation of information from Finland on Juvenile Diabetes and Vitamin D3 - showing a remarkable and direct correlation between dropped VD3 levels and spikes in JD over a period of over 30 years. ==http://www.youtube.com/watch?v=wTtmvMvgfl0==
94. There’s also some research showing that fatter people absorb / produce less vitamin D. I collected a lot of links on this at: not much ==http://living400lbs.wordpress.com/2008/11/07/fat-folks-more-likely-to-be-vitamin-d-deficient/==
99. November 17, 2009 4:28 pm Link
Been there, done that. For once I can say that something has really helped. I took 10,000 IU 5 days/week, for 4 months to bring up my level, once there I made the mistake of stopping over the summer and realized that while I couldn’t put my finger on it, overall, I felt different, it was like I was having the winter blahs in summer.So I started back up and found, much to my surprise, I felt better overall again.
I take VD3 in the form of Cholecalciferol. The current RDA is 400 IU, I now take 5000 IU/day, 5 days per week, the amounts discussed for toxicity due to VD3 in the form of Cholecalciferol, are around 100,000 IU/day…
113. Readers might be interested to know that there are some very strong skeptics of the Vitamin D movement. These skeptics are not affiliated with the “health care industry” - in fact they are a controversial minority, just as the vitamin proponents used to be. Consider the following article strongly attacking the purported association between vitamin D and health improvements: ==http://bacteriality.com/2009/08/10/iom/==
116. November 18, 2009 1:06 pm Link
Vitamin D is critically important for so many medical conditions including fibromyalgia, chronic fatigue syndrome, cancer prevention, etc. “Optimal” Vitamin D levels are way above the 30 ng/mL cited in this study. In my clinical practice, I routinely shoot for levels of 50-100 ng/mL, and for some patients (such as those with Multiple Sclerosis) I push the levels to 75-125 ng/mL. Toxic effects are not seen until Vitamin D levels are way over 150 ng/mL, so I am not causing harm by increasing blood levels this high.
To raise Vitamin D to these optimal levels, I routinely prescribe 5,000 - 10,000 IU per day of Vitamin D3. This has been a very effective therapy for many of my patients.
— Kenneth Woliner, MD
117. …. You probably also know that nothing in biology is as simple as one drug, vitamin, pathway, or disease.
118. #15 you said:
“Correlations are simply not enough. Remember what happened with hormone replacement therapy (HRT) and breast cancer. Correlation studies showed that HRT was associated with less breast cancer, but when subjects took HRT, it actually caused breast cancer when compared to a placebo.”
I say:
It is disturbing to me that misinformation regarding HRT studies is continuing! The reason the study showed an increase in breast cancer was because the HRT given was from an animal/ chemical source–and the human body can tell the difference.
Many people do not know the difference between HRT and BHRT (bioidentical). You should clarify what you are talking about by stating the rest of the truth –i.e. — bioidentical does NOT cause increased breast cancer compared to placebo.
119. November 18, 2009 2:38 pm Link
My recent Vit D level was 24.6 ng/mL in a ‘25-Hydroxy’ test. (which I’m assuming is WigWag’s ‘correct test’–is this assumption correct?). As a result of my tested level of Vit D my doc said “take 1000 IU/day’. I said ‘I already do’ He said ‘double it’. I did, and then I doubled that to 4000 IU/daybased on my own research about Vit D.
Now: I’ve read the very informative entries here from Healthy Librarian, ProfWombat and WigWag and others, and I understand that Dr. Michael Holick gets 2700ng/mL of Vit D daily, but my following questions haven’t been addressed directly. To wit:
Can taking ‘too much’ Vit D have the following iatrogenic effects (by the way, how do we figure out how much is ‘too much’ Vit D?):
1) not all Vit D taken is absorbed due to ’slow’ rate of absorption of Vit D by the human body? and
2) calcium ‘buildup’ on artery walls from non-absorbed VitvD?
If #2 is ‘true’, is such calcium ‘buildup’ akin to cholesterol ‘buildup’ in arteries, and thus dangerous to human health?
I ask these questions because #1 is an apparent point of disagreement between two docs I see regularly , and #2 comes from a recommendation that I take a potassium supplement to ‘counteract’ the ‘buildup’ of calcium caused by taking ‘excess’ Vit D.
Which leads to 2 more questions:
- 1) Is my intake of 4000 IU/day ‘too much’ Vit D for me?
I have been only ’semi-active’ for the past 2 years due to severe non-diabetic–so-called ‘cryptogenic’ or ‘idiopathic’– neuropathic pain in my feet.
This disabling and demoralizing condition has been visited on me after, for many years, my being highly active, e.g. aerobics 3xweekly, recreational biking on weekends, walking a total of 4-5 miles daily r/t to work/back home).
For 5 years I’ve lived in the vast Midwasteland of climate and weather extremes–much too much too-hot sun a good part of the year and much too much gray freezing cold for an equal part of the year, both being somewhat prohibitive of getting Vit D benefits from being out in the sunshine’. These 5 years in Oz come after 60 years of wonderful, year-round outdoor West Coast living.
and
- 2) Is the recommendation ‘correct’ for me to take a Potassium supplement daily? (and, if so, is it for the ‘correct’ reason?)
123. You need to reconsider your claims about the benign nature of bio-identical hormones. Show me the data (long-term clinical trials) that support the idea that bio-identical hormones will not have the same risks associated with conventional HRT. Keep in mind that it is an established fact based on epidemiological studies that life -time exposure to estrogen (exogenous and endogenous) increases a woman’s risk of breast cancer and ovarian cancer. You made an erroneous statement that past(?) studies showed that there was less risk of breast cancer with HRT. What a bogus comment! Many retrospective and prospective studies showed an association with HRT and an increased risk of breast cancer. The red flags were there, but many women and health professionals bought into the propaganda of the pharmaceutical companies and their massive ad campaign. I suggest you go to pub med and start examining the data from the late 1960’s to the present. Start with the Womens Health Initiative–a very important clinical trial. Also, do a search for data that supports your hypothesis about bio-identical hormones.
127. November 18, 2009 7:12 pm Link
Vitamin D is a steroid. It is incomparable to any other human derived molecule.
Now to business….
Hello!!!!! 30 ng/ml as sufficient? Who was running this study- The Marx Brothers?
Once again mainstream medicine stumbles and bumbles its way toward meaningful research, inspite of itself. Any 1st year intern who has bothered to read at least 2 or 3 articles in the last year will know that at least 50 ng/ml activated D in the serum is healthy.Not one nanogram less!
Who is responsible for this idiocy? 30 ng/ml as sufficient? What drug company is hiding the truth?
What we have is a study of a group of extremely sick, deficient people being compared to a group of very sick people.The point being they were all deficient and none of them as far as anyone can tell was at least 50 ng/ml!
128. …. How many thousands of people are going to die as a result of thinking 30 ng/ml is a healthy level? How many millions?
Unfortunately doctors and their egos have done it again. …..
132. It seems like news sites and blogs all practice pack journalism, with everybody trying to discuss the same stories. This month’s fad has been vitamin D, maybe next month it’ll be an old favorite like Vitamin C. I wish there were more contrarian journalists and bloggers.
135. November 19, 2009 4:23 am Link
I am a genetics researcher studying the effects of vitamin D on eye health, but I get scared when I read that vitamin D is a “miracle drug”. People, please don’t go nuts with this stuff. The body needs small amounts of many things to stay healthy, but you can do harm by getting carried away. I take a daily multivitamin pill (a generic version of Centrum Silver{which has vit D2}) that includes 400 IU’s of vitamin A, but only because it was recommended by my primary care provider. I would not take even that common, over-the-counter prophylactic without first talking to my PCP..
139. November 19, 2009 10:09 am Link
In Canada after the release of this study new recommendations in the 1000IU of vitamin d range where issued. The American Cancer Society has thus far not changed it advice .Perhaps some of the walk should be in the sun.
No two interventions seem to hold more promise than statins or vitamin d both have been liked to beneficial outcomes in a variety of settings Interestingly
Statins may in fact work increasing vitamin d levelsan interesting study published in Cardiovasc Drugs Ther. 2009 Aug;23(4):295-9.
140. November 19, 2009 12:02 pm Link
#12 WigWag and others:
My Egyptian-born primary said, “just 15 minutes of sun a day is all you need.” Being 100% Irish-American, I get a sunburn after just a few minutes of unprotected sun exposure. I don’t like sunburns, they are painful, they prematurely age my skin. Did I say they are painful?
It’s very easy to take a 1,000 IU supplement. Meanwhile, you’d have to work at it to overdose on Vitamin D3 (yes, read the wikipedia article to see the doses you’d have to take to become toxic — you’d go broke in the vitamin aisle first!)
And my African-American friends and neighbors would NEVER be able to get all the Vitamin D they need through sun exposure in Baltimore in November.
Breast, colon, prostate, skin, and other cancers, numerous auto-immune diseases, now heart disease. Cause and effect or association? Let’s find out. But meanwhile, take a 1,000 IU daily supplement. It can’t hurt.
141. November 19, 2009 12:49 pm Link
Becky, I know Hollis’s work. he is an author on the Costa Rican study I mentioned. ==http://www.ncbi.nlm.nih.gov/pubmed/19179486?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=9==
The study you cite still found 5% of babies with vitamin D deficiency when the mother was supplemented THREE TIMES the MAXIMUM recommendation (they were given 6000 IU).
Babies must be supplemented. You cannot rely on the mother’s levels. They should be supplemented more aggressivley than the AAP recommendations, as Hollis’s work shows.
I am pregnant and take 500) IU per day, and you can bet my baby will receive oral supplements after birth when I continue breat feeding and D supplementation. I will test levels as well to be sure.
Breast Milk does not transfer enough! Even at doses 15 times the “recommended” level, 5% of infants were STILL deficient by the study you mentioned.
142. November 19, 2009 12:56 pm Link
What is telling about so many posts here is the dis-respect for modern medical practice. “D” is the vitamin “du-jour” because a medical establishment with over 100 years of “scientific” experience just now discovers that much of the population is deficient? If 30 ng/ml is the commonly accepted LOW end the range, why are RDA/DA levels for adults only 400 IU? Are you trying to prevent rickets or have a healthy population?
The enthusiasm with which individuals are self-medicating and willingly believe much of which is counter to standard medical practice is increasing at an alarming rate. You can point to the MMR vaccine; excessive childhood vaccinations, inability to address the epidemic of autistic “spectrum” disorders, the H1N1 controversy, the swine flu laugh 30 years ago, and on and on. The public response is clear (viz: the rise of big businesses in health food stores, vitamin shops and homeo- and naturo-pathic treatments).
If the public losses respect for the CDC, big-pharma, the AMA and countless other groups, including government,what happens when a REAL health problem comes along?
IMHO, it appears that medical practice is at a crisis and that what the public perceives as medical “science” (like the poor study that brought these posts) has become seriously degraded.
— Robert Jacobs
144. thanks vin #139 for the link to a summary of that prospective interventional study about vitamin d and cancer. Here’s the link to the actual journal article, if anyone else wants to read it: “Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial” ==http://www.ajcn.org/cgi/content/full/85/6/1586== got it and the PDF
147. I was recently diagnosed with rapidly-progressing osteoporosis, which my physician attributed to extremely low levels of Vitamin D in my bloodstream.
I was taking synthetic supplements for awhile, but didn’t much care for them. After researching the matter online, I switched to FERMENTED cod liver oil.Yes, fermented, just like the Vikings used to make and eat. I’ve never regretted the switch. Although it’s more expensive than ordinary Vitamin D caps or processed cod liver oil (most brands have “extra” Vitamin D added), my body and I have always preferred real whole (and in this case traditional) foods to chemicals.
While some forms of synthetic vitamin A found in supplements can be toxic at only moderately high doses, fat-soluble vitamin A naturally found in foods like cod liver oil, liver, and butterfat is safe at up to ten times the doses of water-soluble, solidified and emulsified vitamin A found in some supplements that produce toxicity. Additionally, the vitamin D found in cod liver oil and butterfat from pasture-raised animals protects against vitamin A toxicity, and allows one to consume a much higher amount of vitamin A before it becomes toxic.
For more information: ==http://www.westonaprice.org/basicnutrition/clarifications.html==
So far I’m loving using a traditional food to treat my osteoporosis, but I won’t get any definitive test results for a few months. I remain confident that all my test results will be much better.
150. To the concerns with toxicity since Vitamin D is a fat soluble vitamin….
an endocrinologist I work with explains it this way to his patients.
Fat soluble means several things.One is that until all the fat stores in your body are saturated, the vitamin won’t rise in the serum.Rising in the serum is what we want until it reaches therapeutic levels, and then no more than that. This need to saturate the fat stores in the person’s body is why it can take several months for supplementation of Vitamin D to “show” in a rise when it is measured in the blood.
Best way to get Vitamin D is from sun on the skin. But, in northern climes, from late September through into May, it is almost impossible to get enough this way. Thus, supplementation. Getting enough Vitamin D from foodstuffs is not easy.