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The Health Benefits of Vitamin D and Solar UVB (video and transcript) - March 2021

YouTube video
Healthy Society Series: The Health Benefits of Vitamin D and Solar UVB podcast
1 hour: Commenwealth Club of California
Carole A. Baggerly   Founder and Director, Grassrootshealth.net
Carol L. Wagner   M.D., Professor, Pediatrics Department, College of Medicine, Medical University of South Carolina
Joan M. Lappe  Ph.D., R.N., Professor and Associate Dean, College of Nursing Research, Creighton University
William B. Grant   Ph.D., Founder and Director, Sunlight, Nutrition and Health Research Center; Vitamin D Researcher

Carole Baggerly, CEO of GrassrootsHealth.net, will outline the findings of health outcomes of more than 10,000 participants in their studies who take vitamin D supplements, measure their vitamin D levels every six months, and report any health changes. She will also discuss the evidence that vitamin D reduces risk of COVID-19.
  GrassrootsHealth extended refernces on the presentation

Dr. Carol L. Wagner will present results from studies of high-dose vitamin D supplementation of pregnant and nursing women, such as significantly reduced risk of preterm delivery.

Professor Joan M. Lappe will discuss her clinical trials on vitamin D and calcium on prevention of cancer.

William B. Grant, Ph.D., director of the Sunlight, Nutrition and Health Research Center in San Francisco, will moderate the discussion.


Comment - Podcast, which refers to slides, is tricky to follow

Transcript

0:00:10.9 Dr. Robert Lee Kilpatrick: Greetings. Welcome to another program at the Commonwealth Club of California, which since the beginning of the COVID pandemic has gone completely digital. I'm Dr. Robert Lee Kilpatrick, the Chair of the Health and Medicine member-led forum here at the club. And I'm really delighted today to introduce a program in our healthy society series called the Benefits of Vitamin D and Solar UVB, Ultraviolet Light. And of course, Vitamin D is a very hot topic and is often in the news, but many of us don't fully understand the true benefits. So we have four amazing experts here joining us today. I'd like introduced briefly Carole A. Baggerly, who is the founder and director of GrassRootsHealth.net. Hello, Carole. I'd also like to introduce Dr. Carol L. Wagner, MD, who's in the pediatrics department at the College of Medicine at the Medical University of South Carolina. Dr. Joan M. Lappe, PhD, she's a Professor and Associate Dean at the College of Nursing Research at Creighton University. Hello, Joan. And Dr. William Bill Grant, PhD, who's founder and director of Sunlight Nutrition and Health Research Center, and he is a Vitamin D researcher. And Bill is going to be our moderator as well as a speaker today. So without further ado, I will pass the baton to Bill, and I'll see you later.
0:01:47.9 Dr. William Bill Grant: Good morning. Okay, we've just gone through the speakers, but the important thing here is that we have a total of 71 years of Vitamin D research among the four of us. So these are people who have been very dedicated to Vitamin D, have been involved in the research and leading many of the efforts to show what Vitamin D can do. So this is a schematic of how the Vitamin D works. First of all, Vitamin D comes in either through the solar UVB hitting the skin and hitting a layer of cholesterol and being converted to Vitamin D, or it can be obtained from diet or from supplements. Once it gets into the bloodstream, it goes to the liver where it receives a hydroxyl group, becomes 25-hydroxyvitamin D, which is what is measured as Vitamin D level. From there it can go to the kidney where it gets another hydroxyl group and becomes 125 dihydroxyvitamin D, which is the active or hormonal version of a Vitamin D. But it turns out that many other organs in the body can make this hormonal version as needed.
0:03:03.6 Grant: The primary purpose of the hormonal version in the blood is to help regulate the calcium levels in the blood in a very tight range. Now, as I said, Vitamin D is actually a hormone, not just an ordinary vitamin such as Vitamin C. And what it does, it can go to Vitamin D receptors coupled to chromosomes, which occur in almost every cell in the body. And from there, it can tell some genes to turn on, some genes to turn off, and the more of Vitamin D you have, the more genes you can affect. Well, we'll be talking about the functions of Vitamin D in this presentation. And now I'll turn it over to Carol Baggerly who will give her talk about Vitamin D.
0:03:58.1 Carole A. Baggerly: If you've ever gotten tired of being afraid of something going wrong, if you take a look at all the opportunities that you yourself have created to be healthy, one of my greatest messages to you today, I've got three of them, very specific. This one really is to say, "You did it." We now have the largest, the largest worldwide cohort of people all across the world that have created a self-sponsored or a crowd-funded research project. And you collectively have achieved a massive awareness throughout the world of the value of Vitamin D. This has been one of those [0:04:49.2] ??? kind of things for me personally. The other part of the things that I wanted to share with you is a little bit of how you've done it, and where we are, and what the pieces are that you can build on with this awareness, and that we are building on with it every day. The joy in part of all this technology is we can use it, and the using of it includes all the analysis of the data, it includes an approach. If you see on the screen right here, your patient will see you now, there's actually a book just published about that.
0:05:22.1 Baggerly: You as individuals now have more an analyzed information than anybody else in the world about your own health. And the role that this information base can now provide for you is as a consulting role for you to consult with an expert in whatever field that you need to. So it's there, it's ready, and we are actively promoting the use of all of the tools that we have to enable individuals as well as, of course, practitioners and people all over the world to do this. So, enormous thanks. This one is something I think everybody that knows me says, "This is why Carole got into it," which is about breast cancer. I had breast cancer in 2005, and I was stunned. Fortunately, I had the very good fortune of knowing many people in the field already, and not the least of which was Bill Grant himself and Dr. Cedric Garland, right here at UCSD, in San Diego.

Baggerly Charts

 all Baggerly charts for Commonwealth
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0:06:31.3 Baggerly: And one of the things I wanna show you here on this particular chart, which shows published data from two of Dr. Lappe's trials as well as the GrassrootsHealth cohort, 5,000 people... Please take a look at that black line that goes almost straight down from about 10 to 20 is where we started the comparison down to about 70 nanograms per milliliter. You can have an 80%, 82% precisely lower rate at 60 nanograms per milliliter versus less than 20. You will find on all of our research things that we have compared to 20, because that was the thing that was published back in 2012 as being enough. It's not. This is yet another monumental thing that doctors Wagner and her cohorts have worked on, which is preterm births. What does the serum level need to be in order to help prevent that? And they did their RCT, which is that what you see in this black line right here. And then they also worked with us to do a change in standard of care within their facility. To the best of my knowledge, this is the only thing like that that's happening in the country right now.
0:07:54.1 Baggerly: But every single pregnant woman that came in the door, their Vitamin D was tested, and they were working with their physicians to get their serum levels up to 40 nanograms per milliliter. For the preterm birth, right now what we see is, that is what is necessary for preterm birth. It's not enough as a serum level for other conditions that we've mentioned, for example, the breast cancer. This is another slide showing a 60% lower rate with a different kind of category, a specific category of women. This I wanna show you about Vitamin D by race and ethnicity. We read an awful lot of things telling us that the darker-skinned women and/or people have these socio-economic issues. And what we see here is that the major issue is one of color. And the color itself of the skin is what our bodies have been created to use to absorb or protect us from the sun. And if you happen to be very dark-skinned and in a northern continent, you will not be able to get the same kind of level of Vitamin D within your skin which is where our bodies had been built to absorb it.
0:09:19.6 Baggerly: Please note right here, only 2% of the Black women in this group were at 40 nanograms per milliliter or higher. And then, overall, with all the ethnicities within this cohort from the National Health and Examination study, there were only 10% are there. So we really have a very serious issue within, in this particular case, the United States, but really across the world in acknowledging that our skin color is the dominant factor of whether or not we are sufficient. Cost and benefits, I always put in there just to tell you how enormous this is. With breast cancer, there are currently... This data actually was from 2018. But there were 266,000 cases. This is incidence. There has been a lot of work done on treating breast cancer to help women and men survive, but there has been close to zero effort on the prevention aspect, and that is why we are so focused on that. The benefit right here, I use 71% as a figure from another paper that Dr. Lappe published, but that's 180,000 women each and every year. Please attend to that. Type 1 diabetes, this is an annual cost.
0:10:52.3 Baggerly: Know that once you have Type 1 diabetes, it tends to be a lifelong thing. And that's just with Vitamin D, 20,000 people each and every year would not have to deal with this. Pre-terms, we talked about that. That's 190,000 children, and of course families, every single year, that adds up, that hurts. The other number is that for that I just chose to put on here back again to, I think, all health is personal. As we get older, atrial fibrillation has become a big case. And this again is very significantly addressed by Vitamin D, by the magnesium and potassium that go with that, it does not have to exist at this level at all. This is the first paper that we published back in 2011 with doctors Garland and Haney and others. What we wanted to show here, and the reason I'm bringing this up again, is it's one of the most significant things that almost all of you have acknowledged, which is like there is no single dose or intake that is recommended for everybody to achieve the relevant measure of whatever the serum level is.
0:12:10.4 Baggerly: The yellow line is just to show you if everybody takes 4,000 IU a day, somebody might be a 20, somebody might be at 150 nanograms per milliliter, we do not have a magic way of knowing right now what that is, that is why we constantly focus on measuring. Right here, there is a beautiful chart that we put together just from the data itself, always we use that. The Vitamin D intake in order to get to a particular serum for 90% of the population, and that is really key as well, we are not satisfied with an average of the population, we want as many people as possible. But take a look at... If you're 20 nanograms per milliliter and you want to be at 40 nanograms per milliliter, it would work for you to start with 5,000 IU a day. Not one, not two, but 5,000 IU a day, and it is safe. The 10,000 IU a day has been what has been published as the no observed adverse effect level. So that has even been published, and we have not seen any additional things there.
0:13:26.4 Baggerly: I'm gonna go quickly here to this COVID thing, and yes, Vitamin D is definitely related because they build up your immune system in order to help your body protect itself against COVID. Notice that this right here, 190,000 people test showed a positivity rate halved with Vitamin D levels of 55 nanograms per milliliter versus less than 20. It's very important. These are our panel without whom we would not exist. We went around and met all of these beautiful people, and we continue to work with them as our scientists team. Dr. Norman from UC Riverside, Dr. Garland I mentioned, and his partner Gorman, and certainly Dr. Grant here. All of these people are essential. Dr. Heaney, we would talk about this on another session, but he provided the how and what do you measure in order to get accurate results and meaningful results. Dr. Lappe, you'll hear from, and certainly, Dr. Wagner. The other thing that we are looking at right now, which we think is also extremely significant is we're starting to look at what intake and result on serum levels that our users, our participants, have with magnesium, also with omega-3s. And it matters, as Dr. Heaney constantly talked about, all of these different things we put in our body are pleiotropic. They interact with one another, and it matters. What does it take in terms of a plan?
0:15:08.8 Baggerly: This plan and what you do to put together such a practice as we have with you, is the same scientific outline of doing mathematics. On the other hand, it just takes lots of time and lots of people, and the format is still there. And right now, we're into the action part, essentially, of implementation. Next steps, measure the right things. You have to measure the serum level. You have to measure the time of day. You have to measure many things about the body, create new technologies to measure, to educate. We are developing some new educational programs and certifications to provide individuals that magic certificate saying, "I know." And the same thing for various practitioner modules. Given the tools that we have that you know about, new educational methods, these structures, and certainly we will demonstrate the results. One highlight I wanted to highlight before I close is essentially to tell you that with all the stuff that we have published, we have never had to back up and say, "Oops, that wasn't right." Why? Because we are measuring the right things in the right place, the way it has been laid out. Have a healthy rest of your day and life. Thank you so much for all of your efforts in making it happen.
0:16:37.2 Kilpatrick: And now Joan Lappe will talk about cancer.

Lappe Cancer - charts

 Lappe Cancer charts
0:16:40.8 Dr. Joan M. Lappe: Hello everybody. I'm really honored to be here this afternoon to talk about cancer and Vitamin D and take a peek at the evidence. The American Cancer Society estimates that in 2021, nearly 1.9 million new cancer cases will be diagnosed in the US. And that there will be over 600,000 cancer deaths. It would be wonderful if we could prevent some of that cancer and the associated morbidity, mortality, and the dollar cost that's associated with it. Analysis of a National Health and Nutrition Examination Survey showed that about 40% of persons in the US who are 20 and older were Vitamin D deficient. And what I'm gonna talk about will show that there's a relationship between those two groups of statistics. Spending a little time outdoors or using sunscreen when you are getting sun exposure, contribute to Vitamin D deficiency. Hence there's been an interest in using Vitamin D supplementation to augment what we can get from the sun. Dr. Cedric and Frank Garland conducted the first ecological study of cancer and solar ultraviolet B radiation in 1970. They were brothers, and they were both epidemiologists at John Hopkins University.
0:18:07.8 Lappe: And they were looking at an amount somewhat similar to this which shows solar radiation in different parts of the US with more radiation in the blue areas than in the red area. And then they took a look at the cancer statistics, particularly colon cancer in men. And they saw that cancer rates were lowest in the sunniest part of the United States, just sort of jumped out at them. And after considering those data, they hypothesized that Vitamin D was the agent. So since then, there has been an amazing amount of research, and basic science studies have pretty well-established sound mechanisms by which Vitamin D suppresses cancer development and progression. And very simply stated, Vitamin D enhances immune response, which is important preventing those cells from switching to malignant. It promotes self-differentiation into normal cells, normal progression, and promotes apoptosis, which is programmed cell death. Vitamin D also decreases proliferation of abnormal cells, and it inhibits inflammation, invasion of abnormal cells into normal tissues, metastasis, and angiogenesis, which is the development of new blood vessels around tumors, which enables them to survive and to spread.
0:19:45.0 Lappe: So these mechanisms have been found in both in basic science cell experiments and in numerous animal studies, so they are very well established. So I wanna talk briefly about two human studies that my team and I did. The first was a population-based randomized clinical trial in rural Nebraska. We enrolled 1,179 post-menopausal women who were 55 and older, and then we randomly assigned them to one of three groups. Either they got Vitamin D supplementation of 1,100 international units a day and calcium 1,500 milligrams a day, calcium alone, or pills for both Vitamin D and calcium placebos. Now, the reason we chose post-menopausal women and included calcium in our intervention is because our primary outcome was to look out osteoporotic fractures. Our secondary outcome was to determine the effect of these supplements and on cancer incidence of all types of cancer.
0:20:54.0 Lappe: So we followed these women for four years while they took their respective supplements, and these curves show survival that is those free of cancer after four years in each of the groups. So we see here survival of the placebo group, the calcium only group, and the calcium and Vitamin D group. As you can see, the calcium and Vitamin D did much better, and their risk of developing cancer over four years was 60% lower than the placebo group. Now, the calcium only group did better than the placebo group, but it did not reach statistical significance. So then because the primary outcome of our first study was osteoporotic fracture, we submitted a grant to the National Cancer Institute to repeat the study or something similar with cancer as a primary outcome. So we used the same study design, but highlighted in yellow are the major differences. We increased enrollment from 1,179 to 2,300 women, and we increased the dose of Vitamin D supplementation to 2,000 international units. And we cut out the calcium only group.
0:22:16.9 Lappe: Now, I wanna point at the time we did these studies, the recommended intake of Vitamin D was 400 international units a day, so our studies were getting relatively high doses of Vitamin D in those days. But that has changed. Again, we followed the group for four years. So here are the survival curves, the placebo group is represented by the red line, the Vitamin D and Calcium group represented by the blue line. And in this study, the Vitamin D and Calcium group had a 30% lower risk of developing cancer of all types than the placebo group. However, this did not quite reach statistical significance to do that, the value of the P would have had to been less than 0.5. Now, we noticed that during the first year, actually in both of our studies, these groups were pretty much congruent during the first year, and that makes a lot of sense because it takes a while for Vitamin D to be absorbed, to be metabolized, and then to have an effect on any cancer cells. And in fact, we know that there were people who developed cancer in the first year, so they probably came into the study with cancer already existing, but undiagnosed.
0:23:36.8 Lappe: So we did a second analysis, excluding people who developed cancer during their first year of study. And as you can see again, the blue line, the calcium and Vitamin D had a lower incidence of cancer of any type and was 35% lower, and this time it did reach statistical significance. So then most scientists would agree that the most important indicator of Vitamin D status is serum level of serum 25, because two of us could take the same dose of a Vitamin D supplement with all other things being equal, and end up with different serum 25 level. So really, the best way is not to give supplements and see what the outcome, the best way is to look at serum 25, and that's what we're doing here. But this shows along, again, the increasing levels of serum 25, the red line represents the incidence of all type of cancer in our last cohort, and as you can see there was a decrease in incidence of cancer as the serum levels of 25 went up.
0:24:51.8 Lappe: And then we wanted to take a particularly close look at this area that's not shaded. The black lines in this analysis report show the confidence intervals, and they indicate really how much variation are in your data. Once you get to the farther ends, you have fewer people and you have wider confidence intervals and less confidence in your data. So we did an analysis right here to see what this decrease really amounted to, and it was in an area with tight confidence intervals. So what we found was those who had serum 25 levels of 55 nanograms had a 40, 35% lower risk of developing cancer than those who had a serum 25 or 30. So this is interesting and it suggests that we really have to think about what levels of serum 25 are necessary to decrease our risk of cancer. Now, Carole alluded to this, I just wanna mention it again, that there was an 82% lower rate of developing breast cancer in my two cohorts combined with similar women in the grassroots health cohort. 82% lower for those who were 60 nanograms or more compared to those who were less than 20. These are really powerful data. Now, there's evidence from a multitude of human studies that support the anti-cancer effects of Vitamin D. It would take me two hours just to hit on most of them.
0:26:35.9 Lappe: Importantly, numerous observational studies show that higher serum 25-hydroxyvitamin D is associated with lower cancer incidence. I need to mention VITAL, which was a very large study funded by the US Government in which more than 25,000 men and women were randomly assigned 2,000 international units of Vitamin D or a placebo. And that study found that Vitamin D decreased cancer mortality by 21% in an analysis where they excluded those who developed cancer during the first year. So in summary, the scientific evidence strongly suggests that UVB and Vitamin D reduce the risk of cancer. Most scientists and policymakers agree that a minimum level of serum 25 D is needed for optimal health, although controversy exists about what that might... Minimal level might be. Now, Vitamin D isn't a cure-all or a magic bullet, but it's physiologically found that it's needed for overall approach to decreasing our cancer risk. I wanna thank you for your attention, and I look forward to your questions. And I'm gonna turn it over now to Dr. Wagner.

Wagner - pregnancy - charts

 Wagner charts
0:28:02.7 Dr. Carol L. Wagner: Hello? Okay, I'm gonna talk about Vitamin D and the necessity of Vitamin D adequacy during pregnancy and beyond. I have no conflicts of interest or financial disclosures related to this presentation. So why do we even care about Vitamin D? I think you've gotten a hint of that. And let's specifically talk about, "Why do we even care about Vitamin D during pregnancy?" Well, this was back... Now, a decade ago. We looked at Vitamin D status in pregnant women throughout South Carolina. So sunny South Carolina, latitude 32 degrees north. There were over a thousand women. And what we found mimics and certainly parallels what Carole showed earlier, that African-American women who have darker skin pigmentation have the highest risk of Vitamin D deficiency. So if you use the very conservative definition put forth by the Institute of Medicine of less than 20 nanograms per mL, that's in orange, or the Endocrine Society, which uses 32 nanograms per mL, in brown, what you see is that virtually all...
0:29:24.3 Wagner: So 94% of African-American women were either frankly Vitamin D deficient or insufficient. And Hispanic women, about a third are frankly deficient with profound deficiency, less than 20 nanograms per mL. White Caucasian women, about 22%. And overall, about 50% of our pregnant women in a sunny climate are Vitamin D deficient. Next slide. So what influences Vitamin D status during pregnancy? Now, we looked at this in one particular study. It was a Thrasher Research Fund Pregnancy Study, and created a regression model. We looked at age, maternal age, and gravidity, that was not significant in the model. We looked at seasonality, there's a trend, but it wasn't significant, because frankly, if you don't go outside, or if you use sunscreen, that certainly affects your ability to make Vitamin D through your skin. Body mass index is hugely related to Vitamin D status, and those who have an index above 30 were 2.2 times more likely to have profound Vitamin D deficiency, less than 20 nanograms per mL.
0:30:47.1 Wagner: And if you're used to using nanomoles per litre, you just have to multiply the number of nanograms per mL by 2.5 to get nanomoles per litre. We also found that compared to White Caucasian women, African-American women were more than 20 times more likely to be Vitamin D deficient. And if we compare Hispanic women to White women, we see that Hispanic women are more than two times likely to have Vitamin D deficiency. Next slide. So it's not just an American problem though, it's a global health problem. And this is shown in the next slide. So this is a review that we published in 2012, and it really hasn't changed. And what you see is... And we talk about... Some people say profound deficiency is less than 10-12. We consider less than 20 really significant deficiency. But if you use those parameters, what you see here is that even in areas of the world where they have plenty of sunshine, they're along the equator, if there is a cultural reason to cover up for religious or cultural reasons and have less sunlight exposure, or in areas of the world where individuals have darker skin pigmentation, you see much more deficiency.
Many have less than 20 ng of vitamin D
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0:32:20.3 Wagner: You also see in the northern latitudes, so whether you're in the northern hemisphere or the southern hemisphere, as you get on the higher latitudes, you see a greater risk of Vitamin D deficiency. Next slide. So what we learn from other countries can be applied to the US. If we look at epidemiologic data regarding the effects of deficiency during pregnancy, we see a higher risk of maternal preeclampsia in those women who have Vitamin D deficiency, we see an increased risk of pre-term birth that Carole so elegantly showed you earlier. We see an increased risk of gingivitis and periodontal disease in the mother. Next slide. We see impaired fetal growth, and that's really associated with profound Vitamin D deficiency in the single digits. We also see impaired dentition and enamel hypoplasia in the offspring. We see an increased risk of respiratory syncytial virus. We already learned that Vitamin D deficiency is associated with not only COVID-19 infection, but the severity of that infection. And we also see some neuro-developmental differences.
0:33:34.3 Wagner: And so Vitamin D deficiency has profound effects, not only during pregnancy, but later on across the lifespan. Next slide. This was a study by [0:33:46.3] ??? in 2015, and what they showed was that those individuals, those moms who were supplemented with Vitamin D had lower rates of gestational diabetes, gestational hypertension or preeclampsia and pre-term labor. Next slide. We also found this in our studies, and what we've tried to focus on are what are some of the mechanisms. It's beyond this hour to really go into all the gory details, but we found differences in a mediator analysis during pregnancies. This was in our Kellogg Foundation study to prevent health disparities during pregnancy, and we randomized women to 400 or 4,400 international units of vitamin D3 a day. And we looked at their circulating 25-hydroxyvitamin D and nine immune mediators, and we found differences, of course, in those immune mediators. And so it seems that there certainly are plausible mechanisms within the body to explain what we're seeing physiologically.
0:35:10.2 Wagner: Next slide. We also looked at gestational hypertension, preeclampsia, we also looked at gestational diabetes. In the Kellogg study, there were 346 women who participated, and we looked at their 25 OHD and glucose screening values at 26 to 28 weeks of gestation. And we did a model, a logistic regression model to predict maternal glucose at that time, when we controlled for women who had baseline low 25 OHD, BMI and race. And we found that pregnant women with 25 OHD less than 20 were 3.4 times more likely to have glucose values greater than 139. And those with the BMI greater than 30 were 1.9 times more likely to have glucose levels greater than 139. There was no association with race and glucose in the model, which suggests that it's Vitamin D status that's explaining some of the health disparities that we see during pregnancy.
0:36:26.8 Wagner: Next slide. And this is a very busy slide, but what I just want you to focus on is that we looked at the effect of Vitamin D supplementation on the cord blood genome, and specifically at DNA methylation analyses, and found differences on the basis of maternal Vitamin D status. We also looked at maternal lymphocyte profile during pregnancy, and we found that it varies by maternal Vitamin D status. And it seems that early on in pregnancy has a more profound effect than later on in pregnancy. Next slide. And this was a study, and again, it's rather hard to see, but this was a randomized controlled trial conducted in Iran involving more than 1,400 women, and looked at comorbidities of pregnancy or adverse outcomes of pregnancy. And what they found was that the most profound efficiency was associated with higher rates of preeclampsia, pre-term birth, and overall comorbidities. So it's not just in the US that this has been demonstrated. Also in UAE, United Arab Emirates, there have been studies that have been conducted that have shown similar results. Next slide, please.
0:38:03.3 Wagner: The conclusion from our three studies that we've conducted, very large studies, NICHD, Thrasher, and the Kellogg Foundation, pregnancy Vitamin D studies, as well as other studies that have been conducted, that Vitamin D supplementation really impacts African-American women most in their pregnancy outcomes. And it may explain the higher rates of adverse events during pregnancy in this group. Vitamin D status appears to have far-reaching implications on immune function, gene expression in the pregnant woman and her developing fetus, as we've shown by looking at changes in the cells and in gene expression. I didn't have time to go through, but we've also demonstrated placental gene changes as well. So these findings really begin to inform future public health policies surrounding pregnancy interventions for those most at risk. And as Carole pointed out before, we really see more optimal outcomes and health in the pregnant woman if she achieves a total circulating 25 OHD of 40 nanograms per mL. So our recommendations for the pregnant woman is that she should take 4,000 international units of vitamin D3, plus a prenatal vitamin to achieve and maintain a circulating 25 OHD level of at least 40 milligrams per mL. If that woman has a higher BMI, then she's probably... Most certainly, not probably, gonna need more Vitamin D and levels should be checked.
0:39:50.7 Wagner: This approach allows not only the mother, the pregnant woman, but her developing baby to be Vitamin D replete, and it's 25-hydroxyvitamin D that passes through the placenta to the fetus, not Vitamin D, not the parent compound, and not 25 OHD. We believe that all mothers should have their Vitamin D status checked early in pregnancy, and if deficient, should have enough Vitamin D to achieve a healthy blood level throughout pregnancy. And the importance of Vitamin D continues after delivery. So if a mother is Vitamin D deficient during pregnancy, then she and her breastfeeding baby will be Vitamin D deficient during lactation. And we've shown in studies that the breastfeeding mom, if she received 6,400 international units of vitamin D3 a day, she is replete, and her recipient breastfeeding baby is replete and would not need to receive a supplement, and so that's the... I guess next slide. And that's it. And so now it's time for questions and answers.

Q - Diabetes

0:41:05.1 Grant: We have about half a dozen questions here. The first one is for Carole Baggerly. It's, what is the role of Vitamin D in reducing the risk of type 1 diabetes?
0:41:17.4 Baggerly: In terms of type 1 diabetes, the actual biological role is something I will leave for the biologist to address, but it has already been demonstrated first by a study that Dr. Garland did earlier on with the incidence of type 1 diabetes around the equator is less than 5%, and by giving the intake of Vitamin D to get the serum level up back again to that 40-60 range, it does a great deal of inhibiting the development of type 1 diabetes to start with. And we're working on a big project with the Children With Diabetes Association to demonstrate that that can be true also for those that have just been initially identified with type 1 diabetes, you can stop it in its tracks.
0:42:16.6 Grant: Thank you. Second question, multiple vitamins generally have about 600 IU of Vitamin D. Does that mean if we're taking 2,000 and 4,000, we're taking too much, or does that mean that multiple vitamins don't have enough? Carole?
0:42:32.1 Baggerly: I don't think there is a much or a too much, and I would question whether or not the multi-vitamin is the appropriate vitamin to put what might be enough for me and what might be enough for somebody else, and so I don't have any position on that other than I really think that because there is such a variation with different Vitamin D intake levels and the resultant serum levels, that people should be taking Vitamin D supplements, if they're taking supplements individually or per numbers of IU for that Vitamin D supplement.
0:43:10.1 Grant: Okay.
0:43:11.0 Wagner: And it could be actually potentially dangerous if you are trying to achieve adequate Vitamin D through a multi-vitamin that you could actually get, for example, too much vitamin A, if you said, "Oh, well, I need 4,000 international units," and you ended up taking that many multi-vitamins.
0:43:30.0 Baggerly: Exactly, exactly.

Q: 5,000 IU pregnant women

0:43:31.5 Grant: For Carol Wagner, a question about your study with 5,000 IU Vitamin D per day for pregnant women. I think you mentioned that already, but maybe just repeat what the outcome was.
0:43:44.5 Wagner: So they actually got a total... The highest was 4,400 international units. And so we showed that if you can increase that certainly 4,400 increases the Vitamin D status in all women across the three major racial ethnic groups. When you look at it by treatment, you fail to see what we see when you look at it by 25-hydroxyvitamin D, because there are some women who are in the 400, for example, 400 international unit group, who have a level that's 30 or 40 nanograms per mL. And there are women who are in the higher dose treatment group that aren't taking their Vitamin D. So you really wanna use a biological marker like 25-hydroxyvitamin D, and when we look at that, and we look at pre-term labor and pre-term birth, we see a significant difference. We also see lower rates of pre-eclampsia hypertensive disorders of pregnancy, and that's when we combine our data sets.

Q; D in food

0:45:10.7 Grant: Okay, thank you. Next question is how much Vitamin D is there in food? I'll answer that one. In the United States, the average person gets maybe 250-300 IU per day from food, and that includes fish, eggs, milk, and meat. So that's not gonna raise your 25-hydroxyvitamin D very high, so you really don't wanna count on food as a source of Vitamin D.
0:45:38.9 Wagner: I'm sorry, Bill, we actually looked at in over 1,000 pregnant women, and the average American diet, at least in South Carolina, provides about 200 international units a day of Vitamin D, that's using food frequency questionnaires, and that's over 10 years of data, excuse me.
0:45:58.1 Grant: Right, the only thing with the food frequency questionnaire is that it doesn't include the vitamin D in meat, that's in the form of 25-hydroxyvitamin D. So that's why it's a little bit higher if you look at everything.
0:46:08.7 S?: Okay.

Q: Loading dose

0:46:10.0 Grant: Next question, I think for Carole Baggerly, what about taking a loading dose to quickly increase 25-hydroxyvitamin D and then take a standard dose after that?
0:46:21.9 Baggerly: Based on our research and that information that we have worked with over the years, I think it's perfectly fine to take a boost dose and/or a series of boost doses that are in one sense absorbable, meaning like it is not okay to take 300,000 IU, it's just the body can't deal with that, then it actually hurts the body. On the other hand, our position has been and continues to be very strong that people need to take their Vitamin D3 on a daily basis, not on weekly, or twice a month, or something like that. So it's more like here's what the sun does, so let's go forward with that. We have a very sophisticated calculator on our website, grassrootshealth.net. If anybody wants to work with that to see what a potential loading dose might be, Dr. Veith put together some information from a pharmacological perspective, and at this point in time, the highest recommended intake would be 25,000 IU a day over a period of whatever days it takes to get the serum level up, and it's pretty short.

Q: Melanoma from solar UVB, Shadow rule

0:47:40.1 Grant: Thank you. Next question was about the risk of melanoma from solar UVB exposure. I'll handle that one. Yes, but it turns out that the wavelength region of risk for melanoma is more the longwave UV rather than shortwave UV. So UVB which is from 293 50 nanometers, produces the Vitamin D, whereas from 315 to 400 nanometers, it produces about 95% of the UV, and it penetrates deeper than the UVB does, and it's more likely to generate a melanoma. Now, as Cedric at Gorham pointed out, wearing sunscreen actually can increase the risk of melanoma, because that blocks the UVB and it lets in more, and then you stay out in the sun longer and get more UVA. They also showed that submariners had a greater risk of melanoma than the deckhands in the Navy. I've shown that if you look at melanoma rates versus all the cancer rates, maybe 3% of cancer is melanoma, whereas 97% is cancers that mostly are reduced, have reduced risk by UV exposure. So, and it also turns out that if you have higher Vitamin D levels, when you get melanoma, you have a greater chance of surviving, you have lower Breslow thickness and so on. So I think it's just something that we... Well, one other thing, the dermatologists have what they call a shadow rule, which is go out in the sun when your shadow is longer than you are.
   Note:Shadow Rule same length = 1/2 as much UVB/Vitamin D
0:49:26.5 Grant: Unfortunately, when your shadow is longer than you are, you're not going to make Vitamin D, because the UVB is scattered too much, just like the blue light in the sky, and you're getting more of the UVA. So we Vitamin D people have the universal shadow rule which is, if the shadow is shorter than you are, that's the time to be out in the sun. Okay, let's see. I want to discuss just briefly a little bit more about COVID-19. It's been in the news for quite a while now, and it turns out that Vitamin D affects both the innate immune system and the adaptive immune system. Vaccines are only gonna affect the adaptive immune system, but in the innate immune system, Vitamin D induces production of cathelicidin and defensins, which can go out and find the viruses and kill them, they puncture their envelope. And so you're gonna stop the replication of the virus which is going to reduce your risk of progressing to COVID-19. Also, what Vitamin D does is, it affects the production of the cytokines which can be pro-inflammatory and anti-inflammatory.

COVID-19

0:50:38.4 Grant: Vitamin D is gonna promote more of the anti-inflammatory cytokines. And what happens in influenza and COVID-19 is, if the body's immune system goes haywire, it starts producing too many pro-inflammatory cytokines, causing inflammation and increased temperature, which then starts affecting the surface layer of the organs, the lungs, the heart, the vascular system, the brain. And so it's very important that you have higher Vitamin D levels to try to prevent that cytokine storm from taking over. Now, in addition to the serial positivity study from [0:51:24.7] ??? that Carole showed, we also have some prospective studies based on seasonally adjusted Vitamin D levels the year before COVID-19 was developed in patients, both in Chicago, and Israel. And it shows that if you have maybe 30 to 40 nanograms per milliliter, you might have a 20 to 30 to 40% reduced risk of the COVID-19. But there are also some, several studies now showing what happens if you have much higher doses of Vitamin D, around the time when you might get infected or are being treated.
0:52:01.8 Grant: Two sort of accidental studies in France show that if in a nursing home where women were getting 80,000 IU per every two or three months, those women who got 80,000 IU within a month previous or a week after the COVID-19 hit through a nursing home, they had about half the mortality rate. There was about 22% mortality rate versus 44% mortality rate for the women who did not fall in that category. They also show that a hospital treatment with 100,000 IU or more greatly reduced going to the intensive care unit. Then a study in Spain show that using the active form of, well, the 25-hydroxyvitamin D form of Vitamin D given in early stages of COVID-19 greatly reduced the risk of going to the ICU by about 90%, whereas, those who didn't get the high dose of Vitamin D, half of them went to the ICU. So these fall a little short of the large scale randomized controlled trial that the FDA would like for recommendation of Vitamin D for treating COVID-19. But it should be considered as an additional way of protecting yourself, in addition to masks, social distancing, vaccines, and so on. Okay, let's see, I think we have some more questions here, anything else you wanna add to that?
0:53:41.1 Lappe: I would just say, I think it's something that would apply to seasonal flu as well, although we haven't seen probably as much data as with COVID, but any of those viral infections that come around here. And better positioned if you have a bolstered immune response.

Q: Calcium and Vitamin D

0:53:57.0 Grant: Here is a question about, how does calcium interact with Vitamin D. Do you have to worry about kidney stones? Do you have to worry about calcification of the arteries, things like that?
0:54:09.8 Lappe: Well, I'll take a stab at that. Calcium and Vitamin D interact a lot at the cellular level, and we also know that Vitamin D is necessary to facilitate calcium absorption. And so I think there are many mechanisms that are involved in it. In fact, in our studies, we, as I mentioned before, we included calcium because we were first looking at osteoporotic fracture, and we know for sure that calcium is critical for bone health. But there are many other, probably even some unknown interactions that contribute to healthy self-functioning, so you need both in adequate amounts. And as far as kidney stones, that was a grave concern by our oversight committees when we were doing both of our randomized trials. And so we tracked incidence of kidney stones very carefully, and we actually had pathology reports, and we did not see an increased amount of number of kidney stones compared to what you would expect in a population of that age.
0:55:21.6 Baggerly: We also published a paper earlier on with much higher Vitamin D serum levels in the incidence of kidney stones, and it did not increase. And as a matter of fact, there was an endocrinologist, I believe, in one seminar who shook his finger at me and said, "Carole, we only see kidney stones in people that are dehydrated." So all things considered, please don't forget magnesium, it's important for the overall cellular transmission in the omega-3s.
0:55:51.3 Grant: Also, vitamin K2, which we attain from the [0:55:53.3] ??? kinase, helps put the calcium in the heart of tissues, like the bones and teeth rather than the arteries, so that might be considered.
0:56:02.1 S?: [0:56:02.4] ??? [chuckle]
0:56:02.7 Grant: Yeah. Okay, does anybody else have any final comments on Vitamin D? I might recommend, if you wanna get more information on Vitamin D, they can go to https//GrassrootsHealth.net and also https://vitamindwiki.com, run by Henry Lahore. Alright, well, I thank the speakers very much for all your information, and I'll turn it over to Robert now.
0:56:29.5 Kilpatrick: Well, thank you, that was a fascinating talk. The four of you are experts in the field of Vitamin D. And in my experience, it's very difficult to get experts to talk to the public, and you all achieved that today. I learned so much. To me, this is what the Commonwealth Club of California is all about, the ability to get very knowledgeable individuals who understand specialized topics, to talk to people like me who have a broad interest in everything. This is what the Healthy Society Series is all about, which is produced by the Health and Medicine member-led forum here at the Commonwealth Club. So I'd like to thank the four of you, and I hope that we can all follow up as your careers move forward. I'd like to thank our audience today, those of you who are behind the green light on our screens, for attending.
0:57:23.8 Kilpatrick: I would encourage everyone to consider joining the Commonwealth Club of California, very modest monthly fee of $10 gives you access to all sorts of programs. And you can do this by going to the website at www.commonwealthclub.org, where you will also see an amazing array of talks really about all aspects of what's going on in society right now. So in a few days, perhaps a week to 10 days, this program will be available in both an audio and a video format on the website, and of course, you can view that, you can also send a link to your friends and colleagues. And we hope that more people will consider upping their Vitamin D intake, I certainly will. So without further ado, I'd like to thank you, and I hope that you'll attend another talk, soon.
[music]
0:58:20.8 S1: You've been listening to the Commonwealth Club of California. Hear thousands of our podcast on Apple Podcast, Google Play, and Stitcher. If you like what you've heard, please consider supporting our work and help us bring 500 programs a year to listeners like you. Go to commonwealthclub.org/donate. Think your way around the world with our travel programs to exciting domestic and international destinations. And when you're in the Bay area, please join us live at our events. Thank you for listening and for your support.


VitaminDWiki

Books and videos on Virus

Pregnacy

Pregnancy category starts with

766 items in Pregnancy category

 - see also


Healthy pregnancies need lots of vitamin D has the following summary

Problem
ReducesEvidence
0. Chance of not conceiving3.4 times Observe
1. Miscarriage 2.5 times Observe
2. Pre-eclampsia 3.6 timesRCT
3. Gestational Diabetes 3 times RCT
4. Good 2nd trimester sleep quality 3.5 times Observe
5. Premature birth 2 times RCT
6. C-section - unplanned 1.6 timesObserve
     Stillbirth - OMEGA-3 4 timesRCT - Omega-3
7. Depression AFTER pregnancy 1.4 times RCT
8. Small for Gestational Age 1.6 times meta-analysis
9. Infant height, weight, head size
     within normal limits
RCT
10. Childhood Wheezing 1.3 times RCT
11. Additional child is Autistic 4 times Intervention
12.Young adult Multiple Sclerosis 1.9 timesObserve
13. Preeclampsia in young adult 3.5 timesRCT
14. Good motor skills @ age 31.4 times Observe
15. Childhood Mite allergy 5 times RCT
16. Childhood Respiratory Tract visits 2.5 times RCT

RCT = Randomized Controlled Trial


Cancer

Overview Breast Cancer and Vitamin D contains the following summary and sections


Cancer category starts with the following

Cancers get less Vitamin D when there is a poor Vitamin D Receptor


19 Organizations agree that 4,000 IU is OK

__4,000 IU of Vitamin D is OK - 19 organizations agree - 2018
US
Institute of Medicine
Endocrine Society, Vitamin D Council
American Academy of Pediatrics (AAP)
American Academy of Dev. Medicine and Dentistry
Europe
Scientific Advisory Committee on Nutrition (UK)
European Food Safety Authority
Central Europe consensus
Italian Endocrinologists, Italian Consensus
Nutrition - French Society of Paediatrics
European Society for Paediatric Gastroenterology ....
European Society for Clinical and Economic Aspects of Osteo...
The Nordic Council of Ministers
Health Council of the Netherlands

Sources of Vitamin D

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