This edition is slightly later and a little longer than usual. The subject of Vitamin D is so critically important that I just got a little wound up.

News and Views

It turns out that Vitamin D is much, much more than just the bone nutrient. Researchers seem to agree that it helps prevent several cancers, heart disease, autoimmune conditions (e.g. multiple sclerosis), influenza, complications of the flu and in fact, death from all causes.¹ (Hmm, what is helpful for prevention is often helpful in treatment.) It seems likely that in children, deficiency of Vitamin D may well be “THE [emphasis was in the original quote] leading cause of cancer, type 1 diabetes, asthma, allergies, atopy [e.g. eczema], and possibly epidemic autism*.²” The elderly should note that Vitamin D increases muscle strength and brain function while reducing chronic pain. One of my classmates was surprised when horribly painful breast lumps she’d had for decades resolved after she got her Vitamin D levels into a healthier range. That’s an example of a benefit not yet specifically researched. (I did find one intervention study of almost 49,000 post-menopausal women. Researchers found that “a modest reduction in fat intake and increase in fruit, vegetable, and grain intake do NOT [emphasis mine] alter the risk of benign proliferative breast disease. The one variable that did seem to matter was Vitamin D intake.)³ . We shouldn’t be surprised at varied fringe benefits because most cells in the body have a receptor for Vitamin D and it appears to control 1,000 or more of our genes.⁴

THE NEWS: Given all that good news, I was extremely annoyed at recent media scare tactics. They were trying to tell us that people are taking too much vitamin D. The implication was to stop supplements and just get it from sun exposure. (Of course, the media also says to cover up with sunscreen to avoid skin cancer.)

MY 2 CENTS: Don’t these guys have access to the internet so they can read that medical journals worldwide show we’re not getting enough Vitamin D? Pregnant women and their breastfed babies are deficient.**,^5,6 More than a third (36%) of healthy young adults are low.⁷ According to a German study of roughly 1,200 adults, 80% didn’t have blood levels supportive of bone health.⁸ A Stanford study says elderly folks aren’t getting enough and are therefore frailer.⁹ Perhaps as much as 80% of those with chronic illness are deficient. (Do you think there might be a connection?) Even people living in sunny US states have low blood levels. Furthermore, the timid 400 IU/day government intake guideline (or even its 2,000 upper limit) has not been enough to fix the problem.

About the only way currently to know if we are getting enough D is to test blood levels. Dr. Joseph Pizzorno, Editor in Chief of IMCJ (Integrative Medicine; A Clinician’s Journal) wrote 2 great articles reviewing of a number of studies and reported results of a corporate wellness program in which he participated. I’ve put his conclusions into the following chart. Vitamin D test result reference ranges

(The name of the specific blood test is 25(OH)D3. The numbers are as ng/L, the most commonly reported. To convert to nmol/L, multiply by 2.5)

SUPPLEMENT DOSES (proposed by Dr. Pizzorno unless otherwise indicated):10 Note: These are dependent on the amount of sun exposure, skin color and other factors. Therefore, it is recommended to have your blood levels tested and confirm the appropriate dose to reach the optimum range.

* Kids – The government says 200 IU. Many recommend 400 IU, but Dr. Pizzorno points to a study showing that, after 2 years on that dose, most children were still not into an optimum range. A Japanese study had good results with flu prevention and asthma at 1,200 IU per day.11 Some kids may need more especially if the only light on their skin is from the glow of the video game display. Again test, test, test and watch out for the liquid drops because it’s easy to measure incorrectly.

* Adolescents – A daily maintenance dose of 2,000 IU seems prudent.12

* Adults – 5,000 IU daily seems safe and may be a good level for the average adult who doesn’t spend time a lot of time in the sun. [My thought: If you are skittish, 4,000 IU is another common option for the winter at least.)

* Upper limits of daily dose – A routine dose of 10,000 IU/day seems to cause no harm13 (During the summer in the midday sun in a bathing suit, you’d make 10,000 in a few minutes.)

* Playing catch up – If a person’s blood levels are very low and especially if they live in a northern climate, they may need a “loading dose” of up to 20,000 IU per day for 3-6 months.

Toxicity is rare—it’s likely we were intended to spend some time daily in the sun without being coated in sunscreen. Of course, you can overdo anything. The issue is more what you do consistently than individual doses. French researchers gave adolescents single doses of 200,000 IU’s with no side effects observed.14 One reason for the relative safety is that over-the-counter Vitamin D supplements are in a storage form (Cholecalciferol). The body converts that form into the active form (Calcitriol) only as needed unless there is a massive overload of the storage form or some disease process. As always in nutrition, balance is very important. Vitamin A and Vitamin K compete with D and among their benefits help protect from overloading with D.15 (I think I’ll go into Vitamin K next week since many people don’t know there is such a thing.)

Patients have become toxic from being prescribed overly aggressive treatments of the active form. Accidental overdoses of the supplement form have been also been reported but mostly from milk fortification errors and mislabeled supplements (choose brands carefully). Overdoses can result in too much calcium in the blood and in excess that causes mischief. Sarcoidosis patients don’t tolerate vitamin D supplements well.

I’m quite encouraged that so many doctors now test their patients’ vitamin D levels. However, many are still afraid of theoretical toxicity and don’t give doses adequate to bring the blood levels into a healthy range where the patient is better protected. It’s your health and they work for you, so push a little.

Kitchen TIP

I buy sets of graduated measuring spoons and cups wherever I see them at a bargain price (e.g. garage sales). I divide up the sets and dedicate the appropriate measure to a food or supplement container. For example, I use 2 Tablespoons of lecithin granules in my protein drink. Because I leave the same Tablespoon in that container, I don’t have to look for one every time I use the lecithin, nor wash it and put it away…saves only seconds, but they add up..

*Have those researchers who assured us that on average vaccines don’t cause autism even looked at subsets of patients who were perhaps more vulnerable because of a Vitamin D and/or magnesium deficiency at the time?

**Mom is sharing her Vitamin D during pregnancy and lactation. It stands to reason her daily need would be at the upper end of the range for adults. She can at least get regular sunlight if she is afraid of supplements.

This information could save a life! Please take part in our grass-roots health revolution—one tiny step: forward this newsletter to friends and family and encourage them to subscribe.

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¹Arch Intern Med. 2008 Aug 11;168(15):1629-37. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Melamed ML, Michos ED, Post W, Astor B.

²Vitamin D: Still Learning About Dosing, IMCJ, Vol. 9, No 3, June/July 2010. J. Pizzorno.

³Cancer Prev Res (Phila Pa). 2008 Sep;1(4):275-84. Epub 2008 Jul 9. Low-fat dietary pattern and risk of benign proliferative breast disease: a randomized, controlled dietary modification trial. Rohan TE, Negassa A, Caan B, Chlebowski RT, Curb JD, Ginsberg M, Lane DS, Neuhouser ML, Shikany JM, Wassertheil-Smoller S, Page DL.

⁴ VitaminDCouncil.org April 2010 Newsletter

⁵ Clin Endocrinol (Oxf). 2009 May;70(5):685-90. Epub 2008 Sep 2. Vitamin D deficiency and supplementation during pregnancy. Yu CK, Sykes L, Sethi M, Teoh TG, Robinson S.

⁶ Indian J Med Res. 2008 Mar;127(3):250-5. Vitamin D deficiency in exclusively breast-fed infants. Balasubramanian S, Ganesh R.

⁷ What have we learned about Vitamin D dosing, IMCJ, Vol. 9, No 1, Feb/Mar 2010. J. Pizzorno.

⁸ Osteoporos Int. 2010 Jun 17. [Epub ahead of print] Are commonly recommended dosages for vitamin D supplementation too low? Vitamin D status and effects of supplementation on serum 25-hydroxyvitamin D levels-an observational study during clinical practice conditions. Leidig-Bruckner G, Roth HJ, Bruckner T, Lorenz A, Raue F, Frank-Raue K.

⁹ J Intern Med. 2010 Apr 28. [Epub ahead of print]. Vitamin D deficiency and frailty in older Americans. Wilhelm-Leen ER, Hall YN, Deboer IH, Chertow GM.

¹⁰ What have we learned about Vitamin D dosing, IMCJ, Vol. 9, No 1, Feb/Mar 2010. J. Pizzorno.

¹¹ Am J Clin Nutr. 2010 May;91(5):1255-60. Epub 2010 Mar 10. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H.

¹² J Clin Endocrinol Metab. 2008 Jul;93(7):2693-701. Epub 2008 Apr 29. Short- and long-term safety of weekly high-dose vitamin D3 supplementation in school children. Maalouf J, Nabulsi M, Vieth R, Kimball S, El-Rassi R, Mahfoud Z, El-Hajj Fuleihan G.

¹³ J Bone Miner Res. 2007 Dec;22 Suppl 2:V64-8. Vitamin D toxicity, policy, and science. Vieth R.

¹⁴ Arch Pediatr. 2010 Jun 7. [Epub ahead of print] [Administration of a single winter oral dose of 200,000 IU of vitamin D(3) in adolescents in Normandy: Evaluation of the safety and vitamin D status obtained.] [Article in French] Mallet E, Philippe F, Castanet M, Basuyau JP. Abstract in English.

¹⁵ Vitamin D: Still Learning About Dosing, IMCJ, Vol. 9, No 3, June/July 2010. J. Pizzorno.