Doctors try heavy doses of vitamin D to control women's depression caused by metabolic imbalances of diabetes
May 26, 2010 BY MIKE THOMAS mthomas at suntimes.com
Not long after she agreed to participate in the so-called "Sunshine Study" at Loyola University Chicago School of Nursing in Maywood late last year, Jeanette Barnes' life began to change for the better.
Helped by Loyola professor and researcher Sue Penckofer, the study focuses on how increased vitamin D affects metabolic control and depressive symptoms in women with diabetes. With her history of depression and diabetes, the 44-year-old Barnes, a Tinley Park resident, was a perfect candidate.
Jeanette Barnes, a patient at Loyola University School of Nursing in Maywood, says she has seen the benefits of the center's "Sunshine Study" on her once-debilitating problems related to diabetes.
Why? Here's a quick bit of science - - don't nod off: Epidemiologic evidence indicates a relationship between insulin resistance (a symptom of diabetes) and lower levels of vitamin D. Insulin resistance also is associated with depression. Got that? Good. Let us continue.
Penckofer and her colleagues have hypothesized that increased vitamin D may decrease insulin resistance and therefore alleviate depression - - but so far there's insufficient data for any conclusive determination. Vitamin D receptors in the brain and the insulin-secreting pancreas may also play a role.
And there endeth the lesson. Quiz on Friday.
Since December of 2009, after a blood test determined that vitamin D levels in Barnes' body were below (though how far below, she wasn't told) the acceptable minimum of 30 nanograms per milliliter, she has been on a six-month, high-dose prescription supplement that delivers a whopping 50,000 so-called "international units" (IUs) of D per week. And she's feeling better all the time.
"I'm definitely less stressed, and I think I take more time to analyze situations that would possibly cause me to be stressed," says Barnes, who has her six-month evaluation in early June.
As there've been no other changes to her daily routine in terms of exercise, diet or additional exposure to sunlight (a major source of D), Barnes attributes her improvement entirely to the supplement regimen. It's no cure-all, she knows. Depression is "something you have to work at." But at long last, she says, "I'm at ease with things."
Over the past couple of years, especially, more and more researchers have become convinced that vitamin D (which is actually a hormone) may play a key role in preventing and even treating myriad conditions and diseases - - depression among them. Some are more passionate about preaching the vitamin D gospel than others.
In his new book, The Vitamin D Solution, Michael F. Holick, a professor of medicine, physiology, and biophysics at Boston University Medical Center, touts vitamin D's many benefits. Subtitled A 3-Step Strategy to Cure Our Most Common Health Problem, the book enumerates a variety of afflictions that vitamin D (according to Holick and other experts) can allegedly prevent and/or treat: osteoporosis, heart disease, cancer, autoimmune diseases, depression, insomnia, arthritis, diabetes, chronic pain, psoriasis, fibromyalgia and even autism.
As Holick recently told a generally incredulous New York Times interviewer of the latter, "More studies need to be done. What I recommend certainly is that autistic children receive vitamin D, because it improves muscle function."
Holick writes in the introduction that no one gets enough of the good stuff from foods and multivitamins alone. Presumably, that even includes those who consistently consume oily fish such as herring and sardines - - both excellent sources of vitamin D. And those who, hardened arteries be damned, wolf down vast quantities of cholesterol-laden eggs or chug gallons of vitamin D-fortified milk. And cod liver oil enthusiasts.
Hence Holick's theory - - controversial in some circles - - that a reasonable amount of sun exposure is crucial, as ultraviolet B (UVB) rays spur the production of vitamin D (D3, specifically) in the skin. Not everyone agrees. Holick, in fact, was fired from the dermatology department at Boston University for blasphemously advocating sun-on-skin contact - - most prominently in his last book, The UV Solution.
That professional slap in the face hasn't shut him up. If anything, he's testifying louder than ever before.
"It turns out that people who are vitamin D deficient have lots of aches and pains in their bones and muscles and they just feel tired, fatigued," says Holick. "And [after increasing their levels] they have dramatic improvement in feeling and well-being."
Decades ago, Holick identified "the major circulating form" of vitamin D in humans and the active form produced by the kidneys. He has since become known as Dr. Sunshine.
A follower of his own advice, Holick heartily recommends popping 2,000 to 3,000 so-called "international units" per day - with no blood test necessary beforehand - in addition to soaking in some sun (dependent on such factors as skin type and geographic location; The Vitamin D Solution provides a chart).
"I take great pleasure when I treat my patients with vitamin D - - and I eventually give everybody vitamin D, because they're all vitamin D deficient - - and they come back two or three months later and say 'you've just given me my life back,' " Holick says.
Annabelle Volgman, a cardiologist and associate professor of medicine at Rush Medical College, is keen on vitamin D, too. She readily prescribes it for patients who complain of chest pains. Vitamin D is "intricately involved" in calcium metabolism, Volgman explains, and calcium is important in the contraction of muscle cells - - including heart muscle cells.
"We have no idea why it works, [why] these women are having so much improvement in their symptoms when their vitamin D deficiency is treated," Volgman admits. "But hey, it's great for me," she adds with a laugh. "They think I'm a great doctor."
She warns, however, that "we've been burned before" by other vitamins that turned out to have unforeseen risks and/or inflated health benefits.
"There was an association that when you have high levels of homocysteine (an amino acid in the blood), you give people folate, vitamin B-6, B-12, and hope that you can lower the homocysteine," she says by way of example, "but you actually killed more people by giving them these vitamins."
In light of past mistakes, Volgman says, "people are being more careful with vitamin D." And like a lot of physicians - - including specialists and general practitioners - - she always does a blood test to determine D levels before proceeding with treatment. In the face of mounting evidence, some health insurance companies are covering those tests, which cost from around $40 to $225 depending on their complexity. Blue Cross/Blue Shield of Illinois has hopped aboard the D train. So has Aetna. Medicare offers some reimbursement, too, though only enough to cover the basic version.
"It's very important if people start taking this [prescription] Vitamin D, they don't take these huge doses without a blood test," Penckofer says.
Toby Smithson, a dietician with the Lake County Health Department and Community Health Center, advocates testing at any level.
"I definitely recommend getting the test so that you can see if you're taking enough for improvement," she says. "You need a baseline."
While risk for toxicity is considerably lower at the level of 1,000 or 2,000 IUs per day than at the prescription strength, Penckofer says, "some people just go and they start taking this stuff and they don't even think about the consequences."
One of those consequences, she says, is something called hypercalcemia - - too much calcium in the bloodstream, which can cause a variety of ailments such as kidney stones.
Rasa Kazlauskaite, an endocrinologist and medical director of the Rush University Prevention Center, is cautious, too - - despite an amazing case several years back that helped make her a true believer. As part of her former practice at another hospital, Kazlauskaite saw an obese, wheelchair-bound 42-year-old woman who suffered from all-over body aches due to a painful condition called fibromyalgia. The woman was found to have no - zero - vitamin D in her body. After she started on an "industrial strength" regimen, though, her pain subsided significantly. In a year, Kazlauskaite says, she not only was walking unassisted, but her bone density had improved by 50 to 80 percent.
Although Kazlauskaite was thrilled by the rapid progress, and has since seen more heartening evidence of vitamin D's healing properties, she remains healthily skeptical - - particularly when it comes to prescription-strength mega-doses. As of yet, she notes, there's no way to tell what effect they'll have in the long term.
"Let's say maybe it would cause more calcium in the coronary arteries," Kazlauskaite says. "Or more calcium in the aorta. And instead of protecting from high blood pressure, maybe it would cause high blood pressure. So these things still need to be investigated, and that's why I'm saying, 'Really be careful. There's still a lot of questions that are unanswered.'"
Despite such potential pitfalls, Jeanette Barnes isn't ditching her D any time soon.
"As long as my labs are drawn regularly to make sure there's no harmful effects," she says, "I'm thinking I'm going to stick with it."
Hey, whatever makes her happy.
Note: In September, according to its Web site, the independent and nonprofit Institute of Medicine (health arm of the National Academy of Sciences) will release updated "dietary reference intakes" for vitamin D and calcium based on an assessment of "current relevant data."
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