Vitamin D and Health
Australian audience, (talking without charts)
Table of contents
0:00:01.0 Cameron Borg: Welcome to the Ricci Flow Nutrition Podcast. In this episode, I had the pleasure of speaking with world-renowned Vitamin D researcher William B. Grant. William has authored over 280 peer-reviewed articles on Vitamin D and sunlight exposure since 1996. His primary interests are identifying and quantifying the risk-modifying factors for chronic and infectious diseases with a particular interest in ultraviolet irradiance in Vitamin D as well as diet. He's also extremely passionate about getting the messages out that the risk of disease can be modified by diet supplementation and lifestyle choices. William got his BA and PhD in Physics from the University of California, Berkeley. He later found himself working for the NASA Langley Research Center where he operated an airborne laser remote sensing system for measuring ozone and aerosols on many international field expeditions. It is after this where he became interested in the effects of UV light on human health. He has since been doing independent research primarily on the links between Vitamin D and disease. I had such a great time recording this episode. William is such a depth of knowledge and likely unparalleled in his field. We covered a lot during this conversation, which I'm really glad about, and I learned so many things, and I thought I knew a lot about Vitamin D leading up to our chat, so that says a lot. So with all that being said, I hope you enjoy the episode.
0:01:28.4 Borg: : Thanks so much for coming on today to talk to me, William. I've really been looking forward to this. I kind of wanted to get a background on where you started working and how you ended up getting into looking into Vitamin D and studying it from an epidemiologic perspective.*
NASA Physicist
0:01:48.3Grant:Okay. So I guess it goes back to when I was working for NASA in Virginia in atmospheric sciences. And that was a time where back in the '90s, there was big concern about the ozone layer and decrease of that and the increased amount of UVB coming into the earth. And so I actually was studying... Collecting literature on the adverse effects of UVB like on plants and humans. My job at NASA was to work with a laser remote sensing system called LIDAR that could... We'd fly it on an airplane and go around the world and measure vertical profiles of ozones in aerosols, so I was coming in contact with the literature on ozone quite frequently. But on the side, I was doing an environmental project with the Sierra Club, and I took on a task of trying to explain the effect of ozone and acid rain on the eastern hardwood forest, primarily the oaks. And I teamed up with a forestry professor from Ohio, and he taught me how to do what are called geographical ecological studies, or even temporal ecological studies, where you define populations geographically, and then you use these populations as, like individuals, you look at the health outcomes and the risk-modifying factors and do statistical analyses on these entities.
0:03:30.8 Grant: And so we were able to show that acid rain had an adverse effect on the white oaks, whereas ozone had an adverse effect on the red oaks. And in hindsight, we realized that the white oaks often grew in a swampy area, so the roots were in a close contact with the acid rain, whereas the red oaks grew in the dry areas, so the roots were deep and so ozone's the one that affected them. Well, so on one of my NASA trips to New Zealand in October 1996, I picked up the newspaper and found out that a study had been done in Hawaii, called the Honolulu Heart Study, and they had found that the Japanese-American men in Hawaii had 2 1/2 times the rate of Alzheimer's disease as Native Japanese. Well, my mother had Alzheimer's, so I was studying that a little bit and realized that people with Alzheimer's had more aluminum in their brain. And in terms of the forest with acid rain, as it lowered the pH, it had depleted the... Started removing the base cations (calcium, magnesium, potassium), and making aluminum and transition metal ions more readily available because it dissolves the oxides.*
Alzheimer's and diet
0:04:47.4 Grant: And so I said, "Well, gee, these Japanese-American men in Hawaii, probably the thing that was affecting them in terms of Alzheimer's was the American diet." So I said, "I can do an ecological study on Alzheimer's prevalence around the world and find out what causes Alzheimer's." And that was a time when it was thought that Alzheimer's was genetically predetermined. Allan Roses had figured out that APOE epsilon 4 is a big risk factor, end of story. So anyway I got the data for 10 countries... I got the prevalence data for 10 countries, got the macro dietary factors like fat and saturated fat, and sugar and fish and so on. And did a study and found out that total fat and total caloric supply were highly correlated with Alzheimer's in these 10 countries. If you had some ocean fish in a diet like in Northern Europe, you lowered the risk of Alzheimer's, but if you had a diet primarily based on rice, you had a very low rate of Alzheimer's disease.
0:05:54.0 Grant: I then went to the University of Kentucky and gave a presentation. They studied Alzheimer's there and they said, "Fine. That looks great, we'll publish it." They published it in an online electronic journal. I heard a press agent went to the National Press Club in DC and announced to the world that diet is a big risk factor for Alzheimer's. And it got picked up by major TV channels, CNN as well as Dan Rather, on June 17th, 1997. So this is like hitting a home run at my first time batting in the Major Leagues, and just coming from totally outside the field. Of course, the Alzheimer's Association know it's genetics. But it got people interested in working on it, and people in various universities started looking to dietary factors, and were able to confirm some of what I said, and then go on from there. Well, in 1999 this Atlas of Cancer Mortality Rates in the United States, 1950-94 was published (some of the figures are on my website, sunarc.org). What was interesting was that some of the cancers had very high mortality rates, indicated in red, in the northeastern United States, and very low rates indicated in blue in the Southwest. And I had been studying dietary factors in chronic disease. So I tried it for a week or two to see if I could explain those rates by diet.*
Cancer, UV not diet
0:07:34.0 Grant: No, no way. We eat pretty much the same food around the country, a little bit different in the Southeast, but otherwise, it's not the Chinese diet, it's not the Japanese diet, it's the American diet. So then I went back to the seminal paper by Cedric and Frank Garland. Now, they were beginning graduate students at Johns Hopkins School of Public Health when they saw the early version with five gradations on the maps, and the only cancer they could figure out at that time that had a sunlight affect was colon cancer. So they wrote a manuscript that said, here's... If we overlay the annual sunlight rates on the map, contours on the map of the cancers and we find that indeed on the Southwest where there's higher sunlight, you have lower rates of colon cancer. And since Vitamin D production is the most important physiological benefit of of UV exposure, sunlight exposure, we hypothesized that Vitamin D reduces the risk of colon cancer. While they got that idea in 1974, it took them six years to get it published, and then it was in a British journal, International Journal of Epidemiology. And so I had to go back to that and say, well, okay, actually, by the time I got involved in 1999, ovarian cancer, prostate cancer, rectal cancer, breast cancer had also been linked to an increased risk with low sunlight. So I decided to now use the data from NASA.
0:09:19.5 Grant: NASA used satellite data to produce a map of solar UVB from the surface of the United States for July 1992 (also at sunarc.org). So I mapped that into the cancer maps and found there are maybe 13 types of cancer which had an inverse relationship between UVB doses in the summer and cancer mortality rates. I then wrote that out and submitted it to the journal Cancer in 2002, it was accepted very quickly. They just said, well, please have a text editor edit your manuscript. I mean, I'm not that good with words but I have the idea. So I did that, and then once it was published the critics started coming around and saying, well, gee, golly, why did you omit the states along the border with Mexico, and what about the other factors that affect the risk of cancer.*
0:10:11.5 Grant: Well, it turns out along the border with Mexico, you have a lot of Mexicans, and in Mexico, hygiene is not very good, and so a lot of people there had H-pylori infection, which is a very important risk factor for stomach cancer, and I didn't know how to handle that at first. So I put them back in, and now I find that there were data for Hispanic heritage by state and I could use that, and I put in smoking and alcohol consumption, urban and rural residents, and alcohol... I don't know if I said alcohol consumption and poverty status, re-did the analysis, and sent it to nine mainstream journals starting with cancer and they all rejected it, because most of the mainstream journals really are interested in drugs, and they didn't wanna get ahead of the game on Vitamin D. So they all said, well, thanks but no, thanks. One came close but they said, you're not a trained epidemiologist nor a trained statistician, get one of each on your team and we'll reconsider. So then I got Cedric Garland on my team, hired a statistician and sent it back to them and they still rejected it. But I went to a conference of Vitamin D sunlight and Vitamin D conference in Germany, and the convenor of the conference accepted the manuscript for publication in a Greek journal anti-cancer research, and that was published in the year 2006, and now maybe it has 200-250 citations so it's accepted scientifically but it took a very circuitous route to get there.
Writes annual updates on UVB, Vitamin D and cancer
0:11:50.4 Grant: And now, what I do every year, I make an annual update on what's known about UVB, Vitamin D and cancer. But the sad thing is, as I'm seeing in a manuscript I'm drafting now, that despite the over 40 years we've known about UVB or Vitamin D cancer hypothesis, it's still not accepted by mainstream medicine or the public at large. And one reason appears to be that the clinical trials where they enroll people and give them Vitamin D and some a placebo and then look and see whether those who are treated get lower risk, lower rates of cancer incidence have generally failed. There are two reasons for that. One is that they've used, often used people with high Vitamin D levels and given them low Vitamin D doses, generally between one and two thousand IU per day. By comparison, if you go out in the sun every day, you can make 10,000 to 20,000 IU per day, that's all of your skin exposed for an hour or two in the midday sun in Mediterranean or Australia. So first, they've poorly designed the studies, and then they've poorly analyzed the results. What they do is they look at the rates of cancer incidence for those in the vitamin D treatment arm with those in placebo arm with no Vitamin D. Well, it turns out that everybody has a different response to Vitamin D supplementation and a different baseline Vitamin D level so this approach does not give accurate results.*
Dr. Heaney thought cancer clinical trials would need 5,000 to 10,000 IU of Vitamin D
0:13:30.7 Grant: So the fact that you've given a lot of people Vitamin D doesn't mean that you've increased their Vitamin D level that much. What you have to do, which Rob Heaney pointed out in 2014, is you've got to treat Vitamin D as a nutrient and you've gotta design the clinical trials differently. You have to start with measurements of something like their Vitamin D level and you want to try to enroll people with low Vitamin D levels. You then wanna go to the observational studies, find out where the Vitamin D level is, where you get a good reduction and then you have to figure out how much of Vitamin D supplementation takes to go from a low Vitamin D level to an optimal Vitamin D level. So what it's gonna take is around 5000 to 10,000 IU per day to really show a good effect on cancer, and no study has done that.
Blacks cancer almost significantly reduced by 2,000 IU
0:14:31.7 Grant: However, if you look at the vital study out of Harvard, they enrolled over 25,000 people, including 5000 African-Americans, and gave them, in the treatment arm, 2000 IU of Vitamin D in the placebo arm, nothing. They also had an omega-3 arm treatment and control. But if you looked at all 12,500 who got Vitamin D treatment and compared them with those who got a placebo, you found there was no statistical significant difference between for Vitamin D incidence versus treatment or not. You did find that if you omitted the first one or two years of the study, you did get a significant reduction about 25% in all cancer mortality rate but not in incidence. However, if you look at the trial, the 5000 African-American, the Black participants, they had a 25% reduction in cancer incidence, which was just not, just over the line from it being called clinically significant. The peak was 1.01. So it was called a trend. If you looked at those with BMI of less than 25 kilograms per meter squared, again, you had a 25% reduction but it was statistically significant.
0:16:00.0 Grant: So, of course, people with lower BMI can make greater use of the Vitamin D because they have a smaller body mass, less fat and so on. So evidently, the trial, which was initiated in 2010, was not designed properly. That was when the Institute of Medicine was still concerned about the adverse effects of Vitamin D in part because they looked at observational studies in which people with higher Vitamin D levels actually had some more adverse, poor outcomes than people with middle Vitamin D levels, because what happened was they were enrolling some people who had started taking Vitamin D shortly before enrolling in the trial, in the observational study, and had a lifetime of low Vitamin D level. And so they had a recipient who had adverse effects like cancer, cardiovascular disease, etcetera, and came out on the wrong side of the study.
Pointed out that trials needed to look at those with low vitamin D
0:17:02.2 Grant:So I pointed that out in a couple of publications and is now understood but in 2010 they didn't understand that and they didn't understand that you got to look at this serum vitamin D level. Now, the other problem is if Big Pharma were involved and wanted get behind Vitamin D they would very quickly figure out how to design a clinical trial that would prove that Vitamin D worked. They would look at the observational studies, they would look at the doses, they would figure out how many people they have to enroll, they would figure out what baseline levels they'd have to have and they would organize that study, they'd have different universities get involved, and they would quickly find that, yes, Vitamin D works but trials like this are expensive and Vitamin D is cheap, sunlight is cheap, so why bother? Why bother when you can treat people who get cancer and make $100,000 for treating them or sell drugs, or so on? So the medical system is just not interested in Vitamin D. In fact, they treat Vitamin D as the enemy.*
0:18:14.5 Borg: Yeah, yeah, it's a really, it's a big problem. But as an epidemiologist, and this is something that I've been really interested in, you need to establish what is deficient and what is sufficient, and maybe what is optimal and it seems to me as though the numbers we're being told are deficient and sufficient are probably not where they should be. What do you think is the level that is protective for cancer and cardiovascular disease? What should we be aiming for?
Institute of Medicine incorrectly calculated that 20 ng/ml was enough vitamin D
0:18:48.0 Grant: A little background on this. The Institute of Medicine set 20ng/mL as the deficiency back in 2010, 2011, and that was just based on their interpretation of the data for bone health. Michael Holick came along the same year with Endocrine Society, looked at the data and said that they overlooked one important paper in Germany that showed that people who had between 20 to 30ng/mL still had poor bone health. So it really had to be above 30ng/mL. So that time, all you knew was for bone health. Now, as we come along for cancer, for example, the observational studies for breast cancer, very interesting, unfortunately, if you do a prospective study on breast cancer and enroll people and take blood samples in the beginning of study and then follow them for five or 10 years, you'll find after about 3 or 4 years that the Vitamin D level from the blood drawn then no longer relates to developing breast cancer, that's because breast cancer can develop very rapidly.
Breast Cancer risk reduced 80% if Vitamin D levels >80 ng/mL
0:19:57.8 Grant: Mammography is recommended every one or two years, because it can go very quickly from non-diagnosed to diagnosed. Colon cancer is very slow growing, so 10 years is okay. And so they've actually shown in these observational studies that, yes, so even over 10 years, you see something for colon cancer, but for breast cancer, you almost have to use case control studies where you diagnose... Where you look at 20 Vitamin D levels at the time or within a year preceding the diagnosis of breast cancer. And if you get those studies, two papers that I like very much have shown that you still have reductions in breast cancer up to 70 or 80ng/mL. One is a meta-analysis of maybe 20 studies, most of which were case control studies, and it showed pretty much a linear... Just a slightly thin line going down to 20% risk of breast cancer at around 80ng/mL as below 10ng/mL.
GrassrootsHealth
0:21:08.4 Grant: What grassrootshealth.net did was they took individuals from two clinical trials conducted at Creighton University by Robert Heaney and Joan Lappe, and they got the individual data, got their Vitamin D level at baseline, every six months to every year or so, and whether they developed breast cancer. Grassrootshealth.net also enrolls people in community-based open access Vitamin D trial observational studies, in which they take whatever dose of Vitamin D they want, and have their Vitamin D level measured every six months via a pin prick blood spot on a sample which is sent in, which is very accurate by the way. And so they had quite a few women who had enrolled. They only had 77 breast cancer incidence cases out of over 3909 women participating, but that was enough to show a very similar relationship, with an 80% reduction for above 60ng/mL compared to less than 20ng/mL. So this result shows that for beast cancer, the optimal vitamin D level is around 60 to 80ng/mL. You don't just want to be a non-deficient or even what's called a normal or whatever, above 30, you've got to try to get above 60 or 80 ng/ml for optimal.*
0:22:57.0 Borg: Wow. That's, yeah, that's pretty high. It's funny 'cause I've had... I know people who have come back with under 20 nanograms per mL and the doctor just says, "Just take 1,000 units a day and you'll be fine." And it's quite hard to tell people actually, maybe it should be more for a little while, what kind of dosing do you think is good for people who are in that really low level?
He takes 10,000 IU daily, is at 87 ng/mL (135 lbs)
0:23:27.1 Grant: Okay, so for example I weigh around 135 pounds. I have been taking 5000 IU per day and I got around 60, maybe a little above 60ng/mL. When I upped it to 10,000 IU per day, I got around 87ng/mL. So yeah, in the range of 5,000 to 10,000 IU per day due to [0:23:52.1] ??, heavier people need larger amounts than thinner people. If you're really trying to shoot for a goal, like above 60ng/mL, you should have a Vitamin D level measured perhaps with your annual physical check-up or you can get these blood spot tests, which can be fairly inexpensive and reliable. If you've been very low, you might want to take what's called a bolus dose, maybe take 10,000 or 20,000 IU a day for a couple of weeks to get your level up and then go back to a 5000 to 10000 IU per day, so yeah. And it turns out that it's more important to do this during the winter than the summer, but you may as well do it year-round more or less the same amount. The concern about winter is that cardiovascular disease rates go up by 10%, 20%, 25% in winter compared to summer.*
Hypertension reduce by 4,000 IU of Vitsmin D
0:24:55.7 Grant: And there's been a big controversy over Vitamin D in cardiovascular disease because not one clinical trial has been able to show that Vitamin D supplementation reduces the risk of cardiovascular disease. Now, there is a paper from an open supplementation study in Canada from 2017 by Kimball et al., showing if you took over 4000 IU per day to get above 40ng/mL, you can reduce blood pressure by around 10 to 18 millimetersHg, so most of the participants with hypertension who enrolled actually were able to overcome hypertension by the end of the year trial. Now recently, a paper was published on the results of dealing with Vitamin D deficiency in the Veterans Health Administration's hospitals around the country. So this is about a 10 or 20 year study. What they did was they looked at people who were enrolled maybe 10 or 20 years ago, who had baseline Vitamin D less than 20ng/mL So of course, some doctors told them to take Vitamin D other doctors didn't tell them anything. So they had three groups.*
US Veterans Health Administration noticed veterans with high vitamin D were 1.5X less likely to die
0:26:22.8 Grant: Those who still are below 20ng/mL, those who achieved between 20 and 30 and those who achieved over 30ng/mL. And what they found was there was almost a factor of two difference in cardiovascular disease and myocardial infarction and mortality rate between those who were above 30 versus below 20, and maybe a 1.5 factor for those between 20 and 30 versus below 20. So, this is about as good as you're going to get for a sort of a Vitamin D treatment study in cardiovascular disease reduction. And then finally, I think it says that, yes, you ought to be about 30ng/mL, at least for cardiovascular disease, especially in winter.
see VitaminDWiki VA showed increased vitamin D associated with lower health costs - Lancet May 2012
0:27:13.0 Borg: Yeah, right. I wanted to just go back a little bit and ask about the supplementation. Do you think... I've heard some people suggest that large doses all in one go may crowd the liver enzymes that deal with Vitamin D. Do you think there's any benefit to taking 1,000 units, 5-10 times a day rather than just taking one larger dose, or is that just something that you wouldn't worry about?
Vitamin D half life 2-3 weeks, 50,000 IU weekly would be OK
0:27:42.1 Grant:Okay, on a daily basis, it's recommended to take it with the largest meal and perhaps during midday, rather than evening, because it may interfere with sleep. Although getting up to 60 ng/mL has been shown to be beneficial for sleep in the long run. The real concern is whether you take a very large dose once a year or even once a month. Well, on annual doses, they find out people who take them often have an increased rate of falls and fractures. Perhaps because they've been energized and start walking more and then trip and fall. In terms of the monthly dose... Well, let's see, the half-life of Vitamin D level is about two and a half weeks. And the rule of thumb in pharmacology is that you can dose at about half the half-life. So that means in about one week... So if you took like 50,000 IU once a week, that'd be about the... That'd be okay. But taking 100,000 a month, you're going have lots of peaks and valleys, and that's not so good.*
see VitaminDWiki 50,000 weekly fights many health problems
see VitaminDWiki Half-life of vitamin D varies – longer half-life if low vitamin D or got it from the sun
0:28:58.3 Borg: Yeah, I had a conversation with a Vitamin D researcher here in Sydney, and she said that in those studies in New Zealand where they did the annual dosing of 500,000 units or something, what they noticed was that the active form, the 1,25 dihydroxy was depressed, slightly. The active form is not something that's really measured, ever. And I'm not sure I've ever heard it, but do you think for people who have maybe have been taking huge doses their active form might be depressed, slightly?
0:29:39.2 Grant: Well, possibly, but there's also another concern that you're making other metabolites of Vitamin D more pronounced, and they could have some adverse effects. I've seen just a little bit of literature on this, but I haven't pursued it.
0:29:51.7 Borg: Are you talking about the 20 hydroxy... Like the similar metabolites or are you talking about different metabolites?
0:30:02.3 Grant: Well, I think they're ones such as 24,25hydroxyvitamin D. There are a whole bunch of things and I really haven't studied them.*
0:30:12.9 Borg: Right. I wanted to ask you about this idea that you brought up before that a lot of these Vitamin D trials haven't shown benefits in cardiovascular disease. I was just... I had this idea that maybe it had something to do with full spectrum light, rather than the Vitamin D itself and maybe that infrared light may have been playing a role in decreasing cardiovascular mortality, and that's why it's been difficult to show supplementation with Vitamin D is reducing the risks of cardiovascular disease, do you think that's something that could be going on?
Various health problems worse in winter, when there are low levels of vitamin D
0:30:54.5 Grant: Well, I think infrared radiation could have an effect on a cardio system, but given these latest results from the Veterans Health Administration, Vitamin D does play an important role. And like I said, it's been shown to reduce hypertension. There are two of the important risk factors for cardiovascular disease effects are hypertension and inflammation. And Vitamin D does reduce the amount of inflammation. And that's also involved in COVID-19. But the other thing about these clinical trials and cardiovascular disease is it could be that it's just getting below 10ng/mL, that's the biggest risk factor for cardiovascular disease. And people running clinical trials find it very difficult to enroll people with very low Vitamin D levels. They often turn out to be the dark-skinned minority people who are just not gonna take part in clinical trials unless you're well-educated, etcetera, etcetera. And the fact that this tendency... The Veterans' program showed that it was... This correlated more with the low value as well as being more important in winter. It's very interesting that cancers, other than breast cancer, do not have a seasonal variation. Only respiratory infections, other infections and cardiovascular disease have these seasonal variations, and I think for all of these, it means that the very low values in winter, are part of the problem.
0:32:44.6 Borg: Yeah, I've seen really great papers where they can show the rise and fall in mortality going season to season, it's really awesome to... Well, not awesome, but it's quite interesting to see how pronounced those effects are. In your research you've... I think you've established this, 18 cancers that are associated with Vitamin D levels, what other diseases have you found to be associated with varying levels of Vitamin D?
Many health problems are worse when further from the equator
0:33:25.1 Grant: Well, there's Crohn's disease that has a latitudinal gradient. The work in Australia indicates that there's both a UV independent and a Vitamin D dependent contribution to multiple sclerosis, even after DeLuca, who's patented the Vitamin D2, or compounds based on it, has done mass studies, which he shows UV independent of Vitamin D has an effect on multiple sclerosis. Robin Lucas, for example, has worked on that type of program. Multiple sclerosis has a very pronounced latitudinal effect, all the way from the equator, to the high Europe. It's a much stronger latitudinal gradient, than say cancers. For cancers, you can show pretty much that UVB has a role in the single mid-latitude countries, but you cannot use multiple countries. There's too much of an effect of diet on cancer, to do a full latitudinal gradient. Diabetes, is another disease for which now we have good evidence that Vitamin D plays a role. Cedric Garland was involved in a study in Southern California reported a couple of years ago, in which they follow up people for about 20 years and found that those went out to about 80ng/mL down to below ten and found a factor of two or three between those with high and low Vitamin D levels.*
Diabetes 2X to 3X less risk if high (>80ng/mL) than low (<10) vitamin D
So... Oh, diabetes, ah. Diabetes, is another disease for which now we have good evidence that Vitamin D plays a role. Cedric Garland was involved in a study in Southern California reported a couple of years ago, in which they follow up people for about 20 years and found that those went out to about 80ng/mL down to below ten and found a factor of two or three between those with high and low Vitamin D levels.
0:35:06.6 Grant:But also there was, Tufts University who ran a D2d clinical trial. This was looking at conversion from pre-diabetes to diabetes mellitus. That was a 2.5-years study, they gave participant in the treatment arm 4000 IU per day vitamin D3, and they did notice in, when they just looked at dose and response, for various subgroups, they found out some sub-groups had a beneficial effect from Vitamin D and did not progress to diabetes, as much as others did. But finally, last year, they looked Vitamin D levels during the trial and found that for every 10ng/mL increased above about 20ng/mL they found a 25% reduction in progression to diabetes. So this, it had pretty much the same overall relationship in progression to diabetes as the observational study. So this gives a good support to Vitamin D in reducing the risk of diabetes. Now since diet plays such an important role, is another case where you probably want to get up to around 60 to 80ng/mL to make sure you have the full benefit... The good benefits of Vitamin D. Of course, it would help to change one's diet, but if you're not going to do that, you can take Vitamin D.*
0:36:30.1 Borg: Yeah, right. Were there any other ones?
0:36:31.4 Grant: Pardon.
0:36:31.7 Borg: Were there any other diseases that you've studied that show these correlations?
Autism, Dental Carries
0:36:41.3 Grant: Autism seems to show some level with that. We've done an analysis in the United States on the data for young people and autism rate, and it seems to show an effect, inverse correlation with the Vitamin D. And it could be that Vitamin D is reducing the amount of inflammation, which seems to be a risk factor. Dental caries, tooth decay, tooth cavities. Back in the... I did a review of the literature and one of these ecological studies in the United States, it turns out that back in the Civil War in the United States, back in 1865, they looked at the Union soldiers from Maine down to Kentucky or so, and found that those sent to Maine had many more missing teeth than those in Kentucky. There was a real gradient of missing teeth. The first clinical trial of Vitamin D was by May Mellanby, in 1928. And she gave boys Vitamin D supplementation and those who had Vitamin D had a significant reduction in caries.
Cathelicidin: can puncture the envelopes of bacteria and the viruses
0:37:57.0 Grant: Her explanation was, that Vitamin D affected calcium, and so Vitamin D was affecting the growth of the teeth. But being a good scientist, she also used a microscope to look at the bacteria in the teeth, in the cavities and found the bacteria in the teeth were dead. Now, of course, she had no idea that Vitamin D could fight and kill bacteria through induction of Cathelicidin, which can puncture the envelopes of bacteria and the viruses. It wasn't until 2006 that people at UCLA found that Cathelicidin was involved in killing tuberculosis bacteria. And now it's been realized that it is probably the most important reason that Vitamin D kills bacteria and viruses including to prevent dental caries, I think it also plays an important role in many childhood diseases, whether it be measles, or mumps or whooping coughs, which I had as a child growing up in Sacramento. Of course, now we have vaccines and nobody wants to know whether Vitamin D could reduce the risk of these because everybody gets treated with vaccines. I don't know if you want to discuss COVID, there's some evidence that plays a role there too.*
0:39:33.2 Borg: Yeah, I mean there wouldn't be a better time than now, so it seems to me that Vitamin D plays a huge role in the severity of the progression of the infection in a very, very pronounced way. I guess I wanted to know how much do you think it's playing a role, because it seems to me as though the only people that are really getting sick are the ones that have under 20 grams per mL.
COVID-19: observation on prospective studies
0:40:09.6 Grant: Okay, it turns out there is a bit of a problem with the observational studies where they measure Vitamin D level near the time of diagnosis, because COVID is an acute inflammatory disease, and any acute inflammatory disease lowers Vitamin D levels, and so the more severe your COVID is, the more it's going to lower your Vitamin D level. So of course, if you do observational studies, you're going to find an inverse correlation between Vitamin D level and severity of COVID. Now, but there are two other ways to go about this, one is to do prospective studies in which you look at people who develop COVID or become positive, seropositive to SARS-CoV-2, but you get their Vitamin D levels from some time before when they were, came down with the seropositivity or the COVID. So we have studies from Israel, we have studies from Chicago, we have a study from United States based on seropositivity of the virus, and all these do show an effect of... Also, we have a study on African-Americans, United States, showing a very strong effect on pre-diagnostic Vitamin D levels on the risk of COVID or SARS-2.*
COVID-19 treated by high dose Vitamin D
0:41:39.4 Grant: And now, what it appears is that you can get maybe a factor of two reduction in the risk by going to high levels of Vitamin D compared to low levels of Vitamin D. Now, if you go beyond that and ask, well, can you use Vitamin D to treat COVID? So the best results are from Spain, in which they've used the 25-Hydroxyvitamin D called Calcifediol, which... So they're putting in the sort of the pre-form circulating Vitamin D metabolite. So if you take Vitamin D supplements, it might take five days to go from ingestion to developing the 25-Hydroxyvitamin D but if you use these high dose, which is equivalent of 100000, 200000 IU of Vitamin D per day given, they'll give you an equivalent of... 300,000 IU of Vitamin D equivalent over a week, and they find that if you have COVID, go to hospital, that can prevent you from going to the intensive care unit. Now, there was a study in Brazil where they gave people 100,000 or 200,000 IU of Vitamin D but they were already on the 11th day of COVID, they had a lot of... They were... Some of them were already in the ICU. They had many problems and Vitamin D didn't have any effect.
0:43:09.3 Grant:So the two most important effects of Vitamin D in reducing or treating with Vitamin D and as far as I can tell, are first of all, reducing the replication and viability of the virus through inducing Cathelicidin and the second, reducing the risk of cytokine storm. So whenever you get sick, you're going to have these chemical messengers called cytokines and chemokines that are going to go around from cell to cell, telling cells what to do, and in the process, they start increasing inflammation and increasing temperature, it's also part of the fighting a disease pattern, but if you're old, if you're elderly, if you have chronic diseases, your inflammation, your immune response may go haywire and you'll start producing too many of these cytokines, but because they're not working, you keep producing more, it's like the [0:44:13.4] the Sorcerer’s Apprentice that kept filling these buckets of water till it floods everything, and once you get the damage from the cytokine storm, it will go to the vascular system, to the brain, to the kidneys, to your lungs, etcetera, and start damaging the surfaces.*
Want >55ng/mlL to prevent/treat COVID-19
0:44:35.3 Grant: And once you get the damage, it takes a long time to repair it, you've got to start rebuilding the organs, you've got to first of all get rid of these cytokines and the virus, and then start improving. So a lot of people who develop COVID, now what's called long haul COVID because of all the damage, so the important thing is, if you want to prevent COVID, you want to do high dose of Vitamin D supplementation to improve your immune system, and what Michael Holick showed in terms of preventing it, preventing the seropositivity, is you want to be above 55ng/mL and then what the Spanish show is that if you're goint to treat it, if you haven't been taking Vitamin D you might want use the preformed 25-Hydroxyvitamin D in high dose form to get in there quickly and increase your Vitamin D levels.*
0:45:38.5 Borg: Wow, 55 nanograms is very high, isn't it?
0:45:41.7 Grant: Yeah.
0:45:44.1 Borg: Yeah, well, there seems to be, and not just for COVID, but there seems to be a huge disparity between the health of people of color and White people regardless of what country or where in the world you are. I think you've done some commentary on this. How much of that disparity do you think could be explained by the fact that the more melanin you have, the more time in the sun you need to generate Vitamin D?
Blacks have low Vitamin D levels
0:46:19.1 Grant: Okay, in the United States, the average Black inhabitant has an average value around 16ng/mL, the average Hispanic around 21, and the average White around 26. Now for the Whites, it goes up to nearly 30 in the summer and down to 20 in the winter, but average around 25, 26. So Blacks have about 40% lower Vitamin D levels than Whites and Hispanics have about 20% lower. Now, we did publish a paper a few months ago where we looked at the effect of Vitamin D supplementation on risk of various health outcomes for Blacks and Whites and point out that maybe not so much for cancer incidence but certainly for cancer mortality rate, it played a role and for diabetes, it plays a role, for respiratory infections, it plays a role. We didn't have good data for cardiovascular disease at that time, but we do now, and it would play an important role there. And fully, in the United States, Black residents are reluctant to listen to Whites in terms of what they should do because there's a lot of bad history of Whites and Blacks in terms of health outcomes.
0:47:40.4 Grant: And the Black doctors are not interested in telling the Black residents about Vitamin D because they'd rather treat them with drugs and surgery and all that sort of thing. We've contacted many Black physicians and only found one or two who are interested, otherwise, they just don't really care. So it's been really hard to communicate the message to the African-Americans, and they don't really know much about supplements anyway, and they're not gonna spend more time in the sun. When they worked in the fields, of course, they spent more time in the sun, but now they work more in offices, or stay home, or stay with air-conditioning so they're not getting that kind of Vitamin D that they used to, so it's a hard problem.
0:48:21.6 Borg: Yeah, I think I've heard Dr. Holick say something about needing between four and 10 times the amount of UV to make the same amount. And then you put the obesity problem on top of that, and the fact that the more fat, the adiposity you have, the more Vitamin D you need. So is there something that we should take into consideration when figuring out the supplementation dose based on weight? If someone's really obese, should we be going maybe 10,000, 15,000, 20,000 units a day, and then walk me through from there?
10,000 to 50,000 IU per day appears to be OK
0:49:04.7 Grant: Well, doctors always try to look at safety issues, and for Vitamin D, the Institute of Medicine said that the upper tolerable limit was 4000 IU per day. But they said they found no adverse effect up to 10000 IU per day. So I think one can argue with the doctors that 10000 IU per day is okay. Now, there is a doctor I'm working with, Dr. PM McCulloch in Ohio. He works at a hospital for prisoners and psychiatric people, I guess psychiatric people primarily. And he will give them five to 10 to 50 thousand IU per day. He gets informed consent, and he monitors their Vitamin D levels, and he's found no adverse effects in his patients. He has uncovered some hypercalcemia, which is not due to Vitamin D but to underlying factors, no kidney stones, etcetera. He's found, he's been able to reverse psoriasis in some cases, with his high dose up to 50000 IU per day. So in a person who's really treating in Vitamin D and is going to monitor the people, that works pretty well. Now if you can get a doctor who will listen that you can get them to maybe work with the people and help them with that.*
see VitaminDWiki: 5,000 or 10,000 IU Vitamin D for 7 years both safe and effective (4700 patients, 8 months to plateau) – Jan 2019
Cofactors, Vitamin K2, Vitamin C
0:50:33.0 Grant:Now, there's another problem with taking high dose Vitamin D in terms of co-factors. First of all, magnesium is involved in the enzymes that convert Vitamin D to different metabolites. So you may be taking maybe 4000 IU, 400 milligrams of magnesium per day, not the oxide form, which is too tightly bound, but citrate or something like that. You also want to take Vitamin C, maybe one or two grams a day, because one of the effects of Vitamin D is to try to reduce inflammation, so it sort of uses glutathione in that process, and glutathione use that up, you need Vitamin C to replace and replenish it, so one or two grams of Vitamin C. And then you've got to worry about if you're taking too much calcium, either from diet or from supplements, you probably want to reduce the intake a little bit, but also think about using Vitamin K2. A good source of that is Nattokinase, you get the powder form. So what Vitamin K2 does is it tells the body where to store the calcium in the hard tissues, the bones, and the teeth, and not in the arteries and veins, you don't want to get calcified arteries because you get hypertension and so on.*
Increasing Vitamin D may need to increase Vitamin Bs as well
0:51:55.9 Grant: So you might want to consider all those things, over the short-run it doesn't matter. Oh, and another thing, it was found that in the sleep study that after two years of taking enough Vitamin D to get up around 60 ng/mL, some of the patients that were being treated said, "Well, we're feeling painful. Overall pain. What's the cause of that?" Well, fortunately, the doctor working with the patients found out that as you change your Vitamin D level, you can change your gut biome. Now, the gut biome, you have all this bacteria and mold and whatever that interact with each other and so the by-products of one part of the biome might be the intake for another part of the biome. Well, what happened was the B vitamins got used up in the system, and the B vitamins will help reduce the risk of pain. And so, what she found was by giving the patients the what's called B-100 tablets, which have 100 mg of each of the B vitamins, That within a month or two or so, it restored the balance of the gut biome and the systemic pain went away. So that's one more factor to consider, and Vitamin D has been shown to reduce the systemic pain. Often as people with low Vitamin D around 5 to 10, 15 nanograms per mL, often dark-skinned people, in the United States who have systemic pain, and they can reduce that pain by taking Vitamin D.*
0:53:36.0 Borg: Wow, I knew it interacted with the gut bacteria and B vitamins, but I didn't know about that study. That's very cool.
0:53:43.1 Grant: I'll send it to you.
0:53:44.9 Borg: Awesome, awesome. I also wanted to backtrack. I think you wrote a paper on the association between Vitamin D and anemia.
0:53:57.7 Grant: No.
0:53:57.9 Borg: No, okay. It must have been someone else.
0:54:00.9 Grant: I have read some, but I haven't written.
0:54:01.2 Borg: Right.
0:54:01.8 Grant: Ed Giovannucci has, for example, at Harvard.
0:54:04.8 Borg: Okay, right. Do you know what that interaction might be? How that might be affecting?
0:54:12.2 Grant: Not exactly, but it does bring up an important point about pregnancy, it's been aggressed there. So the GrassrootsHealth Group works with Carol Wagner and Bruce Hollis at Medical University of South Carolina and did an open-label study on supplementing pregnant women at time of their first prenatal visit. They had a lot of Hispanics, Blacks, some Asians, and a lot of Whites. They drew blood samples and gave them a free bottle of 5000 IU Vitamin D capsules and counseled them on how much they had to take to achieve a vitamin D level over 40ng/mL. At the end of the study, those who had below 20ng/mL had a moderately large number of pre-term deliveries, less than 37 weeks gestation. If you looked at above 40 compared to less than 20, there's about a 60% difference in pre-term deliveries. So preterm delivery is very expensive and very adverse health effects, etcetera. So they showed that you really wanna take like 5000 IU per day when you're pregnant to avoid that.*
Vitamin D needed during Pregnancy
0:55:40.3 Grant:The other things that's been shown very well is reduced risk of pre-eclampsia, which is essentially high blood pressure during pregnancy. So pre-eclampsia, pre-term delivery, C-section delivery, and anemia are the four horsemen of increased risk of maternal mortality during pregnancy. Michael Holick did a study, an observational study, where they showed that women who had over 30 or 40ng/mL vs. less than 20 ng/ml had a much lower rate of needing a C-section delivery. And one of the problems with C-section delivery is you can have a lot of blood loss if you don't quickly patch the women up. And so you want to try to avoid that if you can. Although it's becoming much more elective now than compulsory. And then if you're nursing an infant, you've gotta take maybe 4000 IU per day of Vitamin D in order to have 400 IU per day of non-converted Vitamin D in the breast milk, so the nursing infant can convert that to 25-Hydroxyvitamin D. It doesn't wanna see pre-formed 25-Hydroxyvitamin D. It wants to see native Vitamin D, so.*
0:57:09.7 Borg: Wow, yeah. I guess moving on to a little bit of a different direction. There's a bit of a controversy about whether Vitamin D2 and Vitamin D3 are equivalent or should be used. What are your opinions on the D2, D3 debate?
Use Vitamin D3, not D2
0:57:34.0 Grant: I come down on the side of D3 and oppose a D2. What Michael Holick says is, well, D3 is used by doctors because of patent and they can easily get it from the pharmacist and give it out in 50,000 IU capsules. Well, there's also high-quality vitamin D3 in 50,000 IU capsules, and it can be prescribed. So that argument sort of falls away. But if you look at this trial, for example, trials on D2 and D3 and all-cause mortality rate, D3 has shown maybe like a 16% reduction in all-cause mortality rate. D2 has actually shown a somewhat of an increase in mortality rate with taking D2. The half-life of Vitamin D2 or 25-Hydroxyvitamin D2 in the body is shorter than for D3, and it's really based on vegetable... It comes from yeast or from fungi, and it's not the same molecule as D3, and you wouldn't expect it to have the same function in the body. So I think that if you look carefully at all the studies, it is not so good a way to go. Now, if you're a vegan and you want to have no animal products, you can take Vitamin D2, but you probably are going to take more and expect less from it. And I keep arguing with my friends about that and they won't budge. [chuckle]*
0:59:02.6 Borg: Yeah, right. Okay, well, yeah, I think D3 is the... It just makes sense because it's the human form. We touched on this a little bit earlier, but you wrote a commentary on the Big Pharma Disinformation Playbook, and possibly purposefully delaying the acceptance of Vitamin D as a treatment or even an adjunct to treatment. Can you talk a little bit more about what you think is going on with this delay?
Medical system is opposed to Vitamin D, it would decrease their income
0:59:38.1 Grant: Sure. We have a medical treatment system, not a disease prevention system. And like I mentioned, there's a lot of money we made in treating cancer, both pharmaceutically and surgically. I heard about the Disinformation Playbook from the Union of Concerned Scientists, and they outlined how it was first applied by the tobacco interest and then the sugar interest, the football interest, etcetera. And I looked into it, and looked at the five tenets of it. The first one is to try to show that the so-called experts in the field are not very credible or believable. For example, Michael Holick is number one Vitamin D expert in United States. So, three years ago, about three years ago, there was a big hit piece in the New York Times saying that he took money from vitamin manufacturers, he took money from the indoor tanning industry, he took money from the Vitamin D blood level measurement people, therefore he's tainted. Well, never mind that doctors take money from big pharma when they do these trials, are they tainted? *
Disinformation Playbook
1:01:05.2 Grant: Sure. We have a medical treatment system, not a disease prevention system. And like I mentioned, there's a lot of money we made in treating cancer, both pharmaceutically and surgically. I heard about the Disinformation Playbook from the Union of Concerned Scientists, and they outlined how it was first applied by the tobacco interest and then the sugar interest, the football interest, etcetera. And I looked into it, and looked at the five tenets of it. The first one is to try to show that the so-called experts in the field are not very credible or believable. For example, Michael Holick is number one Vitamin D expert in United States. So, three years ago, about three years ago, there was a big hit piece in the New York Times saying that he took money from vitamin manufacturers, he took money from the indoor tanning industry, he took money from the Vitamin D blood level measurement people, therefore he's tainted. Well, never mind that doctors take money from big pharma when they do these trials, are they tainted? *
1:02:58.9 Grant: I think there's a fifth tenet, but I think you get the idea that whatever way they can, they try to discourage Vitamin D and to keep... It's just business practice to try to do what you can to protect your market and discourage the simple opponent... Simple ways to oppose it. It's very sad.
Germans could save 254 million Euros annually if supplement with Vitamin D
1:03:25.9 Borg: Yeah, it is. It's very, very sad. And I found this paper a few months ago that suggested that supplementing the older adult population of Germany could probably save 30,000 cancer deaths per year and a potential net savings of 254 million Euros per year, just by supplementing the elderly population of Germany. I'm thinking even if they've drastically overestimated that it's still such a large difference in just giving a subset of the population enough Vitamin D to keep them from deficiency. I know it's hard to put a dollar value on these things but that's an enormous amount of savings in public health, why aren't governments jumping at this idea?
see VitaminDWiki: Mortality and vitamin D – great chart Dr. Grant, Germany
1:04:25.7 Grant: Well, governments are run by corporations and lobbyists. We've got the best government money can buy and Congress, a lot of people and even Democrats are, you have a lot of money from Big Pharma and they won't oppose Big Pharma on pricing. So, we don't get to bargain for rates. We pay a lot more for drugs in the United States than in many other countries, like Canada. And so, people have often gone across the border to get drugs, but now they can't even cross the border because of COVID. Canada won't let the Americans in very much. United States said about 20% of its GDP, gross domestic product, goes to healthcare, and as my colleague at vitamindwiki.com points out, if you had a, say you had a big health maintenance organization like Kaiser-Permanente, if you had them promote Vitamin D where they told everybody, "Get your Vitamin D level upto 60ng/mL." Now they might lose half of their 200,000 employees. So they can give lip service to Vitamin D but they can't really put it in big practice. You might recommend to your viewers that www.vitamindwiki.com, operated by Henry Lahore, who's a retired Boeing Aircraft Engineer, who just spends every day, full-time every day, sucking in all the Vitamin D literature he can and putting it on his website, and making it so it can translate to any language you want.
GrassrootsHealth
1:06:01.5 Grant: Then there's www.grassrootshealth.net, run by Carole Baggerly, who started that about 2007-2008, with help of Cedric Garland. She calls herself, "A breast cancer treatment survivor." She had a mastectomy, radiation treatment, chemo treatment, hated every one of them, and only... Her family physician said, "You have osteoporosis, you should start taking Vitamin D." And she looked in, and started finding that, well, Vitamin D could have prevented breast cancer. And she was furious with the medical system. And so she started this, it's called, grassrootshealth.net, because she realized that she's not going to convince the medical industry, so she has to target the people at large. I also like scholar.google.com. It's a very easy place to get Vitamin D papers. They'll often tell you where you can get a free copy and who has cited... How many papers have cited any particular paper. So you can trust the quality of the paper that way, so it's easier to work with, than pubmed.gov, although pubmed is now showing who cited various papers, but it's not going to show you necessarily where to get a free copy.*
1:07:24.8 Borg: Yeah, yeah. That's a big problem as well. I don't think this stuff should be behind a paywall, particularly now, but fortunately, there are ways to get around it, and that's where I've got most of my papers on this. One of the things that I was really, really wanting to talk to you about was the association between sun exposure and skin cancers because it seems to me as though Vitamin D is a perfect little compensatory mechanism to help deal with the impact of UV light, and from my understanding, the relationship between sunlight and melanoma is not clear whatsoever. So, can you talk a little bit about the three types of skin cancers, and how they relate to sunlight?
Dark skin 2-4 X less Vitamin D from the sun
1:08:21.1 Grant:Okay, let's go back one step first. Nina Jablonski and George Chaplin have gone around the world studying skin pigmentation, both before you've been exposed to sun and after you've been exposed to sun. And they figured out that if your heritage is between 20 and 40 or so latitude Northern Hemisphere, you had the ability to tan, because in winter, there's very little solar UVB, if any, so as the sun recedes, you've got to lighten the skin to be able to get more penetration to the layer of 7-Dehydrocholesterol under the skin to make Vitamin D. But in summer, as the sun becomes more intense, you've got to put a tan layer on, which is a factor of 2-4 times longer than with pale skin. Then there's another thing that's been found recently is that, if you have high Vitamin D levels, you can actually stay in the sun longer because you're not gonna get the inflammation. It's going to help reduce the inflammation, I guess by reducing cytokine production.
Melanoma thinner if high Vitamin D
1:09:31.6 Grant: Now, I'm getting to melanoma. Melanoma is an evasive cancer just like colon cancer, and breast cancer, and so on. And so, Vitamin D has the usual mechanisms, first it's going to try to find melanoma cells and kill them or not to let them progress. And if you start to develop melanoma, it's going to try to reduce the angiogenesis, the formation of blood vessels around the tumor, which are required to bring more nutrients to that. If you can get beyond that, Vitamin D's going to try to help it, part of it, from metastasizing. Because a tumor, if it's constrained, is not going to kill you, but once it starts getting into the other tissues, it does then. So, what they found in Australia and elsewhere is, that if you have high Vitamin D levels, your thickness of your melanoma is thinner because the Vitamin D is playing an important role..
Melanoma - avoid the Australian sun, take Vitamin D
1:10:31.8 Grant: Now, squamous cell carcinoma, which is moderately deadly, is mainly due to UVB exposure, and I guess it's causing mutations, and then it starts going the other way. Basal cell carcinoma is caused by both UVA and UVB, is very seldom fatal, and I'm not sure what the role of Vitamin D is in reducing the risk of progression of both those types of cancer. But the problem in Australia is that many people have the Celtic skin: Red hair and freckles, inability to tan well, inability to... And so, they're at great risk of developing melanoma and probably the other cancers as well, in fact, that's why indoor tanning's been banned in Australia, and people are told to be careful in the sun, etc. And I think that's good advice for Australia in the summer because the sun is closer to the Earth during the austral summer, because the ozone layer is thinner, and also Australia and New Zealand are just closer to the Equator than, say, the United States is. So a lot of factors suggest that you have got to be careful in the sun in Australia. But they have found that cancers and multiple sclerosis and other diseases do have a latitudinal gradient in Australia. So as you go further south in Australia you do get an effect of protection from Vitamin D. But if I were an Australian, In today's lifestyle, I'd probably rely on supplements rather than Vitamin D supplementation for my Vitamin D.*
UVA - generates Nitric Oxide
1:12:43.4 Grant: On the other hand, there's a factor we haven't mentioned, and that is related to long-wave UVA, which can stimulate the release of nitric oxide into the blood, which lowers blood pressure and fights infections. And there's Richard Weller in the UK, and Dr. Gorman in Australia who are studying the effect of nitric oxide on COVID-19 and pointing out that part of the reason that COVID disappears in the summer is that UVA, through producing and releasing nitric oxide, helps kill it, as well as the Vitamin D effect killing it. And now it turns out that you're gonna make Vitamin D only when the shadow is shorter than you are. It's the reverse of the dermatologist shadow rule. They say go out in the sun when your shadow is longer than you are, and we say go out when your shadow is shorter. But in Australia perhaps the shadow rule, the dermatologists' shadow rule is okay in terms of nitric oxide release, for example, for COVID, so maybe a morning and afternoon sun might help you reduce the risk of COVID and blood pressure, but you do want to take your Vitamin D supplements.*
1:14:14.7 Borg: What do you think about the idea... I've seen a few people suggest that melanoma is only increasing in indoor workers and outdoor workers who have occupational exposure seem to have either no effect or a protective effect. Why do you think melanoma is increasing in people who are exposed to less sunlight?
Melanoma increased if less sunshine
1:14:40.8 Grant: Because their Vitamin D levels are lower, but also often, there may be some local effect of UV exposure on melanoma. I did do a study in Nordic countries where I used occupation as the factor to look out, and I used lung cancer incidence less lip cancer incidence, and found that melanoma rates were slightly lower in the higher occupations than in some of the other occupations. So if you're an indoor worker, so suppose you're a waiter or something, or a night shift worker, maybe go to the beach once a week, and so you get sunburned and that's a risk factor for melanoma because you're not making much Vitamin D. So I think that's part of the reason that the indoor workers have a greater risk. Of course, Cedric Garland and colleagues show that the submariners had a greater risk of melanoma than the deck hands in the Navy some decades ago.
1:15:42.0 Borg: Yeah, their work is very, very cool. I read in a paper, I can't remember who was the lead author on that, but something about UVA without UVB actually being able to break down Vitamin D in the skin and through windows.
1:16:03.3 Grant: Yeah, yeah. Anne Webb, and also Dianne Godar wrote papers on that topic*
UVA may destroy some of Vitamin D produced by UVB
1:16:12.0 Borg: So is that something that people need to worry about if they're exposed to light through windows where the UVB is being filtered out, but the UVA is still getting through?
1:16:23.0 Grant: Well, there has been some concern that people who drive commercially on the road quite a bit and have, their glass will block the UVB, but not the UVA. You might be getting a little bit more UVA there. I think UVA is a risk factor for melanoma and UVA, shown by Holick and Webb, wavelengths up to about 331 nanometers can also reduce the concentration of Vitamin D. It interacts with some of the metabolites and destroys them. So if you're in the sun, you can never produce too much Vitamin D because you have the breakdown as well as the production.
1:17:01.1 Borg: Yeah, I guess that's one of the built-in safety mechanisms to sort of keep a level titrated where...
Africa
1:17:12.3 Grant: And in Africa, they find that the pastoral people in East Africa might have levels around 40-45ng/mL. These are people, they have some clothes, but they're out in the sun all day with their flocks or whatever. Now we're finding that going to higher levels is beneficial in terms of reducing risk of some diseases, so maybe we didn't have it quite right in terms of the upper limit.
see VitaminDWiki: Africa
1:17:37.6 Borg: Right, yeah, well, it seems like the potential harms are very overstated, and it's really an extremely safe thing to supplement with even at high levels. In your work as an epidemiologist, what are some of the strongest associations that you've seen with Vitamin D?
1:18:00.9 Grant: Well, some of the recent work on serum Vitamin D levels and incidence of several types of cancer, breast, colorectal, bladder cancer, yeah, several other cancers, cardiovascular disease has a very, very strong inverse correlation between vitamin D levels and cardiovascular disease and stroke. Yeah, like I said, the problem about adopting and recommending Vitamin D to reduce risk of cardiovascular disease, is that the clinical trials with low dose and high, people with high vitamin levels haven't found an effect. There's all sorts of infections, especially infections that are more common in winter, Vitamin D helps protect against those, helps pain, helps with the bone, with dental caries when people are young, periodontal disease.*
1:19:09.6 Grant: Now, I had a post-doc position in Berlin in the early '70s when I was in my early 30s, and I lurked in a laboratory and didn't know a thing about Vitamin D and spent much time in the sun. I had five cases of colds during that two-year period, and when I returned to California, I was diagnosed with periodontal disease. So what Vitamin D does is it helps kill the bad bacteria in the mouth that cause periodontal disease and so that's how I got that. There's also evidence that Vitamin D maintains good cognitive function and reduce the risk of Alzheimer's disease and cognitive decline. And it also has shown in Nordic countries from a melanoma study, and the author of the study said that he looked at mortality rates for participants in that study and found that those participants who had a higher sun exposure had 30% lower mortality rates than those with lower sun exposure.*
1:20:24.6 Borg: It is Lindqvist, is it?
1:20:26.6 Grant: Pardon.
1:20:28.4 Borg: The lead author's name is Lindqvist?
1:20:31.4 Grant: Yeah. Lindqvist.
1:20:33.1 Borg: Yeah, yeah. Those two studies are quite fascinating, really. Yeah, I think the people who had the least sun exposure were likened to the mortality rate of those who smoked.
1:20:46.7 Grant: Right, right, exactly.
1:20:48.2 Borg: Yeah.
Patients who got to 70-80 ng.mL of Vitamin D reduced their medical office visits from 4/year to 1/year
1:20:49.2 Grant: I have a doctor friend in the United States who's... He started giving his patients, have them take 5 to 10,000 IU/day of Vitamin D and they got to around 70-80ng/mL. And as result, instead of coming in four times a year they came in once a year. As a result, working in a small town, he ran out of patients and had to close his practice. And so that's a hazard of doctors telling the patients to take a lot of Vitamin D.
see VitaminDWiki: Does Less Sun mean More Disease video
1:21:23.4 Borg: Yeah. That's a good/bad thing to happen, I suppose. It's noble. So what are you working on at the moment? And what are you hoping to look into in the future?
Published COVID-19 paper, working on Cancer paper
1:21:38.8 Grant: Okay, well, I published the first article suggesting that Vitamin D will reduce the risk of COVID-19 and then the mechanisms would be reducing of inflammation, cytokine storm and destroying the virus. And that was the highest cited paper in 2020, it has over... I think it's up to over 1250 citations by now according to scholar.google.com. It's sort of fun to watch the publication come in and watch it play in the media and all that. I've been working on cancer for over 20 years, and I'm preparing a manuscript now, trying to explain why we should think that Vitamin D does reduce the risk of many types of cancer. I'll be presenting this at a conference in Warsaw on October. The problem is that if you look at all the studies and combine them in meta-analysis, you see an effect for Vitamin D in blood levels, but you don't see an effect for supplementation. And so I've got to make the case that you've got to look at the best studies with the highest supplementation levels and the highest doses, highest results. I'm busy working in trying to make that manuscript.*
Is 60 to 80ng/mL the optimal Vitamin D level?
1:23:03.7 Grant: The other thing I'm doing is trying to write a related manuscript showing that first of all, trying to overcome Vitamin D deficiency is not what you want to do, that you really want to look at Vitamin D for optimal health. Michael Holick said in 2011 that it's about 30, grassrootshealth.net was able to show in 2017 or earlier that if you look at what you know from vitamin D studies in the blood, that it's between 40 and 60ng/mL where you want to be, because that's where a lot of these outcomes have their optimal effects. What I'm sure they're finding now with looking at diabetes and some of these more recent cancer studies that you really want to think about aiming towards 60 to 80ng/mL. So the second manuscript is on the evidence that 60 to 80 is where you want to be. Now, it's probably very few physicians who will take this up, but maybe some researchers will take it up, maybe somebody will start doing a little study and hopefully in a few years be accepted, but may be quite a few years if we still don't have an acceptance like cancer after 40 years, it's very long. But I learned as a graduate student, so just being there for the long haul.*
New findings often come from people outside of the field - Physics, Medicine, etc,
1:24:33.9 Grant: I also learned when I was studying physics in Berkeley in the '60s, that often the new findings, the revolutionary findings in one field can be made by people who come from outside the field, because they don't accept the paradigms of the field. For example, many doctors are taught that if you take too much Vitamin D it can have adverse effects like hypercalcemia because it's fat soluble. It's nonsense. But what I also learned is that people who come from outside the field may have new approaches, such as the ecological approach that the medical system is totally at odds with, they totally just dismiss it, but it's like doing an unplanned experiment with millions of people, and you have all these data to harvest and analyze, it's so inexpensive to do and so powerful, but is just thought as, well, it's a hypothesis, now let's go improve it with clinical trials, which they put a plan. I'm not earning money to speak of as being a medical practitioner, I'm a physicist doing epidemiology and I just find it's good science to try to, you know, find out what's really going on and try to help save lives and try to promote simple ways by changing diet and Vitamin D supplementation and so on, to make people healthier.
1:26:05.7 Borg: Yeah, I really hope your message continues to echo. You're a big name out there and I'm really glad that we got to have this conversation today. I learnt so much, and I feel like you could just keep going and rattling off probably everything that's ever been studied about Vitamin D, but I think this will be a nice place to wrap up. Did you have anything else that you wanted to put out there and let people know?
1:26:38.1 Grant: No, thank you very much for inviting me. I look forward to seeing the podcast and promoting it as well.
1:26:45.4 Borg: Cheers. Thanks.
1:26:47.2 Grant: Thanks.
1:26:49.5 Borg: Hey guys thanks for sticking around for the whole episode. I really hope you enjoyed our conversation and that you learned something new. I'd like to encourage people to go and check William's work out. He's the co-author of a book called Embrace the Sun with Marc Sorenson. If you'd like to hear about a bit of my work, feel free to follow me on social media using @ricciflownutrition. I've got many great guests lined up for the future so make sure you keep in touch. Thanks so much and take care, everyone.
- * Paragraph was edited for clarity by Dr. Grant
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