Doesn't the Vit A in cod liver oil prevent absorption of Vit D?
EC: Hi Maureen,
According to a recent newsletter from Dr. Cannell, yes, it does: http://www.earthclinic.com/supplements/vitamin_d.html#NEWSLETTER
(Michelbach-le-bas, Alsace, France)
Cod Liver Oil
Vitamin A is an essential nutrient for healthy skin and mucous membranes, for differentiation of cells particularly for the developing embryo, it helps maintain the immune system and is essential for the function of the eyes (the visual process). Vitamin A is called retinol and we can make it from the beta-carotene (and a few other carotenoids) found in highly coloured fruits and vegetables. However, fruit and vegetable consumption in many countries is very low and, therefore, the intake of beta-carotene is low, too. Retinol occurs naturally in liver and liver products, dairy products, some fish and in cod liver oil. Cod liver oil is one of nature's richer sources of retinol as well as vitamin D. We are unable to comment on the amounts of A and D in cod liver oils marketed in the United States which is where the authors of the paper reside. What happened to cod liver oil in the USA or how it is marketed may be different from the practice in other countries. In the UK cod liver oil the oil has for many decades contained A and D in an approximate ratio of 10:1 based on the amounts in International Units (I.U.). There is a British pharmacopoeial standard for the oil which has specified for many years no less than 600 I.U A and no less than 85 I.U. D per gram. The European Pharmacopoeia specifies, per gram of oil, no less than 600 I.U. and no more than 2500 I.U. of A and no less than 60 I.U. but no more than 250 I.U. vitamin D. Both reflect the ratio of A:D in natural cod liver oil of around 10:1('as nature designed it').
Vitamin D is essential for the absorption of calcium from food and, consequently, it is required for development and maintenance of healthy, strong bones and teeth. Recent research is suggesting that the vitamin may have more and important actions. Very few natural foods contain vitamin D and most of the body's vitamin D comes from the action of sunlight on the skin. The vitamin is fat-soluble (as is A) and it can, therefore, be stored. This is important because the excess made beyond our immediate requirement could be stored for use at a later date. However, the fact that we rely on sunlight has a downside in that the sunlight needs to be of useful strength in order for us to make vitamin D. At higher latitudes, the time and the amount of useful sunlight are short and low, respectively, during late autumn, winter and early spring. This means that body vitamin D status may be compromised and it is the authors' personal view that this is a public health problem that should be addressed urgently.
We also feel and agree that vitamin D nutrition and, therefore, status should be improved. However, we cannot comment on the view of the authors on how they see that this should be achieved. It is possible that A may interfere with D at the level of the cell but this needs to be investigated meticulously before conclusions can be drawn and recommendations can be made by Government departments or agencies. Retinol has been around in nature for a very, very long time and cod liver oil was given to many people in several countries as the first supplement of vitamins D and A. In the UK, in the early days of the second World War, cod liver oil was given away in clinics to pregnant women, nursing mothers and children under the age of five years because of food restrictions and the fact that many women would need to work in factories and other places and would, therefore, be less exposed to sunlight. This continued until the late 1950s/early 1960s.
Cod liver oil has been taken for decades by many generations of people and without apparent adverse effects. Before suggesting that cod liver oil is anything but beneficial, more quality research needs to be done to find out what any interaction between these vitamins means. Only with sound scientific evidence on the actual interaction and the levels of each vitamin that may cause this interaction can authorities make (dietary) recommendations with reference to the intakes of these vitamins and to any maximum level of A (and D) in supplements and foods.
EC: Who are the authors of this article? Kindly send us a link to your source! Thank you for the information.
(West Valley City , Utah)
(Redondo Beach, Ca)
Vitamin D and Why it May Not Be Working For You as Well as it Should
Many people take vitamin D because it is noted for many health benefits in hundreds of studies, but for some reason, some people do not seem to be able to obtain benefit from vitamin D. Many people are aware that there are cofactors for vitamin D such as boron, zinc, magnesium, vitamin K-2 and calcium, but we often do not realize how important these cofactors can be in terms of helping vitamin D to be all it can be for our health.
On that note, here is a very brief and easy to read article that clearly and simply explains why magnesium is absolutely needed in order for vitamin D to completely do the job it was meant to do in our bodies.
On a related note, the following very short abstract describes how not enough vitamin D and / or not enough magnesium can potentially create health problems for us!
I came down with the flu last week and a friend mentioned taking Vitamin D three days in a row and also putting hydrogen peroxide in the ear. I went a few days later when I was feeling better to Whole Foods and the only kind I could find was Vitamin D3. Most of the brands were made from liver sources, which I thought might be high in mercury, so I settled for vitamin D3 from Lanolin - also cholecalciferol. Anyway, I have been taking 1-2 softgels (2500 IU) a day with food. Immediately the raspy cough that I can't quite kick disappears. The amazing thing is that my psoriasis around my nose disappeared after taking the first dose. But both the cough and the psoriasis came back when I stopped a few days later. My thought is that I am not taking enough D3.
Question to those who know about Vitamin D3 -- How much is a good daily dosage? If it takes 30 minutes to get 10,000 IU from sitting out in the sun, I imagine you can take at least that amount. I am seeing that some people take up to 50,000 IU a day, but that seems a little high to me!
(South Bend, IN)
This is a reminder for everyone taking D3 to please check the list of ingredients on their bottles of vitamin D3 to see they contain Cod Liver Oil (and therefore vitamin A). I just checked the list of ingredients on my huge bottle of D3 softgels that I got at Costco (Kirkland brand) a couple of weeks ago and saw that they contain Cod Liver Oil. What a bust! The bottle does not list vitamin A in the Supplement Facts section, only vitamin D3.
"Cod liver oil contains more vitamin A and more vitamin D per unit weight than any other common food. One hundred grams of regular cod liver oil provides 100,000 IU of vitamin A, almost three times more than beef liver, the next richest source; and 10,000 IU vitamin D, almost four times more than lard, the next richest source. Of course, cod liver oil is only consumed in small amounts, but even a tablespoon (about 15 grams) provides well over the recommended daily allowance for both nutrients."
The problem is that even small amounts of vitamin A negate the benefits of vitamin D. From the Dr. Cannell's latest newsletter:
"... the benefits of vitamin D are almost entirely negated in those with the highest vitamin A intake. And the retinol intake did not have to be that high in these older adults to begin to negate vitamin D's effects, about 3,000 IU/day."
(Whitehous Station, Nj)
Dear Ted, my mother toke overdose off d3 by mistake and now she is sufering from the toxity of d3 "870 nmol". She is in the hospital now given the treatment for lowering the calcium. How can we detox d3? Kindly help ASAP
Dear Earth Clinic:
I've recently started supplementing with 2,000 I. U. of Vitamin D nightly, before bedtime, in the hopes that it will help with my depression. The Mirena IUD ruined my emotional state (causing not only depression, but panic attacks, anxiety and ridiculous mood swings), and I've spent the last five years trying numerous supplements and "therapy" to get back to "my old self". Needless to say, I haven't had much luck. In any case, when I take the Vitamin D at night, I've noticed upon waking that I have a lot of phlegm in my chest; it takes me about half an hour to cough it all up. At first, I thought that it may either be due to a recent cold or the fact that I get recurring sinus infections. However, I remember reading somewhere that Vitamin D is good for the lungs, so I'm wondering if the phlegm is a good thing? Should I continue to take it? If so, should I decrease the dose or increase the dose?
Thanks in advance for your help!
Latest newsletter from the Dr. Cannell and the Vitamin D Council. Please pay particular attention to the paragraph about the harmful effects of Vitamin A and why people should avoid cod liver oil like the plague!
..."However, hidden on page eight is one sentence and a small table, which shows that the benefits of vitamin D are almost entirely negated in those with the highest vitamin A intake."
The Vitamin D Newsletter
Remarkable Paper in British Medical Journal
February 28, 2010
This is a periodic newsletter from the Vitamin D Council, a non-profit trying to end the epidemic of vitamin D deficiency. If you want to unsubscribe, go to the end of this newsletter. If you are not subscribed, you can do so on the Vitamin D Council's website.
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A few weeks ago, the British Medical Journal published a remarkable paper, remarkable that it studied more than 500,000 subjects, remarkable that it had 56 (fifty-six) authors, remarkable that it confirmed low vitamin D levels obtained in the past are a risk factor for developing colon cancer in the future. However, the most remarkable part of the paper is that the 46 scientists minimized the true significance of their own research. They found that vitamin A, even in relatively low amounts, appears to thwart vitamin D's association with reduced rates of colon cancer.
Jenab M et al. Association between pre-diagnostic circulating vitamin D concentration and risk of colorectal cancer in European populations: a nested case-control study. BMJ 2010;340:b5500
This is a prospective nested case-controlled study, which means it uses subject's vitamin D blood samples obtained and frozen in the past and then reviews their medical records into the future to see who gets colon cancer, comparing the study subjects to similar members of the group that did not get the illness. Dr. Mazda Jenab and his 45 colleagues from the International Agency for Research on Cancer confirmed that low vitamin D levels are a risk for colon cancer in a dose response manner; those with the highest levels were about twice as less likely to develop colon cancer compared to those with the highest levels.
However, hidden on page eight is one sentence and a small table, which shows that the benefits of vitamin D are almost entirely negated in those with the highest vitamin A intake. And the retinol intake did not have to be that high in these older adults to begin to negate vitamin D's effects, about 3,000 IU/day. Remember, young autistic children often take 3,500 IU of retinol a day in their powdered multivitamins, which doesn't count any additional vitamin A given in high single doses.
This is the largest study to date showing vitamin A blocks vitamin D's effect and explains some of the anomalies in other papers on vitamin D and cancer. For example, Dr. Rachael Stolzenberg-Solomon of the NIH conducted two similar studies on pancreatic cancer, with startling different results. Her first paper showed high vitamin D levels tripled the subsequent risk of pancreatic cancer, her second paper showed no effect. The difference, the first was conducted in a cod liver oil country, Finland, the second in the USA.
Stolzenberg-Solomon RZ et al. A prospective nested case-control study of vitamin D status and pancreatic cancer risk in male smokers. Cancer Res. 2006 Oct 15;66(20):10213-9.
Stolzenberg-Solomon RZ, et al. Serum vitamin D and risk of pancreatic cancer in the prostate, lung, colorectal, and ovarian screening trial. Cancer Res. 2009 Feb 15;69(4):1439-47.
Prostate cancer is another good example; ten similar studies have been conducted on vitamin D blood levels and the risk of subsequent prostate cancer. Dr. Lu Yin of the German Cancer Research Center reviewed them in detail. Eight of the studies found no relationship but two studies found a U shaped curve, that is, an increased risk of prostate cancer at both lower and higher vitamin D levels. You guessed it; both of these studies were from Nordic countries where cod liver oil consumption is rampant.
Yin L et al. Meta-analysis of longitudinal studies: Serum vitamin D and prostate cancer risk. Cancer Epidemiol. 2009 Dec;33(6):435-45.
So why is there no relationship between vitamin D levels and the future risk of prostate cancer? All the subjects had their vitamin D levels checked in the late 1980s or 1990s, well into the sun-scare but before the vitamin D revolution. So how did these older people get high levels of vitamin D back then? Multivitamins? No, they only contained a meaningless 400 IU. Vitamin D supplements? No, they were not widely available back then and only contained a meaningless 200 to 400 IU of vitamin D if available. Sunshine? Maybe, but I doubt it. Studies have shown that the elderly were the first to abide by sun-avoidance advice; anyway, the elderly lose the ability to make vitamin D from sunshine; it takes the elderly up to ten times more time in the sun that the young to make an equivalent amount of vitamin D.
However, the elderly of many countries, not just Nordic countries, were raised on cod liver oil and I suspect that a sizable number of Americans continue to take cod liver oil as they age. While cod liver oil from the 1980s and 90s had higher amounts of vitamin D than does modern cod liver oil, it still had toxic amounts of A. I suspect if authors of the above ten studies had controlled for cod liver oil intake, they would have found that high retinol intake was blocking the cancer-preventing effects of vitamin D.
I say this because one author has controlled for retinol intake and the pre-cancerous condition, colon adenomas. Dr. Kyungwon Oh, of the Korea Centers for Disease Control and Prevention, working with Harvard epidemiologists, found that high retinol intake completely thwarted the beneficial effects of vitamin D, stating, "a higher retinol intake, approximately > 4,800 IU/day, appears to counter the beneficial effect of vitamin D . . ." In other words, exactly what the British Medical Journal paper found with colon cancer.
Oh K et al. Calcium and vitamin D intakes in relation to risk of distal colorectal adenoma in women. Am J Epidemiol. 2007 May 15;165(10):1178-86.
Let"s look at Dr. Pamela Goodwin"s study from the University of Toronto that studied breast cancer survival. This a very different study as it looked at vitamin D levels obtained after the diagnosis of breast cancer and subsequent survival in 535 Toronto women between 1989 and 1996. Vitamin D levels ranged from 3 ng/ml to 70 ng/ml. The women with the lowest levels were about twice as likely to die and to suffer distant cancer recurrence compared those with the highest levels. Ten year survival was 85% for those in the upper one-third of vitamin D levels compared to 74% in the lower one-third. However, the data suggested a U shaped curve for the women with levels above 40 ng/ml, that is, a higher risk of dying, but it was not statistically significant.
Goodwin PJ et al. Prognostic effects of 25-hydroxyvitamin D levels in early breast cancer. J Clin Oncol. 2009 Aug 10;27(23):3757-63.
Again, let"s ask where women would get levels above 40 ng/ml in Toronto between 1989 and 1996? Sunshine? We know the answer is no as the authors found no seasonal variation in 25(OH)D levels in the 535 women, even in the women with the highest levels. So where did blood levels of 40-70 ng/ml come from in the early 1990s? Vitamin D supplements were not widely available in the early 1990s, and only contained meaningless doses when available. As sunshine was ruled out, they could only have gotten it from cod liver oil. I have emailed Dr. Pamela Goodwin, lead author, asking how hard it would be to see if cod liver oil use was asked about in the dietary questionnaire and if she could control for cod liver oil intake. She did find retinol intake was associated with higher vitamin D levels but I am particularly interested in cod liver oil intake in women with vitamin D levels above 40 ng/ml.
It's not just in breast cancer that vitamin D levels appear to have a treatment effect; it's in lung, prostate and colon cancer as well. Again, these are studies of people diagnosed with cancer to see if high vitamin D levels at the time of diagnosis are associated with improved survival.; that is, do high vitamin D levels have a treatment effect? On average, those with the highest vitamin D levels at time of diagnosis lived 2 or 3 times longer. One has to ask how high vitamin D levels are associated with greatly improved survival once you get cancer but a higher risk of getting cancer in the first place. That requires some gymnastic thinking and acrobatic basic science.
Zhou W et al. Circulating 25-hydroxyvitamin D levels predict survival in early-stage non-small-cell lung cancer patients. J Clin Oncol. 2007 Feb 10;25(5):479-85.
Ng K et al. Clin Oncol. 2008 Jun 20;26(18):2984-91. Circulating 25-hydroxyvitamin D levels and survival in patients with colorectal cancer. J Clin Oncol. 2008 Jun 20;26(18):2984-91.
Tretli S et al. Association between serum 25(OH)D and death from prostate cancer. Br J Cancer. 2009 Feb 10;100(3):450-4.
Remember, studies of vitamin D levels and subsequent risk of cancer are only one type of epidemiological study. Studies of latitude and cancer are quite clear, the less sunshine the higher the cancer risk. Studies of dietary vitamin D intake and cancer are also mostly supportive but such studies are limited by the tiny doses people get in their diets.
So it is not just autistic children that are being harmed by vitamin A. Avoid cod liver oil like the poison it is and check your multivitamins. Life Extension Foundation just reformulated their multivitamin to contain only 500 IU of preformed retinol. And, I am happy to report that Purity Products, which markets my vitamin D, has no preformed retinol at all in any of their multivitamins, only beta carotene. Purity has also stopped selling cod liver oil. Now, if only Carlson, Solgar, Nature's Way, and other companies would stop selling cod liver oil and stop selling their concentrated vitamin A supplements to a country whose problem is widespread sub-clinical vitamin A toxicity, I'd be a happier agitator.
John Cannell, MD
Vitamin D Council
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Dr. Cannell's Vitamin D Newsletter
This is The Vitamin D Newsletter for May, 2008 from the vitamin D council. I think you should post this on the web site every time it comes out. The post about sunlight & eczema tells us just how important sunlight and Vitamin D3 are to our systems.
Yesterday's Washington Post article, To-Good-To-Be-True, sums up the April 9th vitamin D symposium at UCSD in San Diego, which was nothing short of spectacular. Carole Baggerly outdid herself organizing it and explaining how she got involved. Make no mistake; Carole is both serious and energetic. She told about her efforts to introduce resolutions at upcoming meetings of various professional groups. Then she introduced the volunteers from the San Diego Black Nurses Association who made sure the conference went off without a hitch. Then Carole introduced the four speakers. The slides of each speaker are available at Grassroots Health. Before I tell you the highlights of the conference, I'd like to tell you about another conference, this one in Germany, this May 17th and 18th. It is the Third International Symposium on Vitamin D Analogs in Cancer Prevention and Therapy. Readers know how I feel about giving analogs to vitamin D deficient patients instead of vitamin D but speakers include Michael Holick, Reinhold Veith, Bill Grant, Tai Chen, Heidi Cross, David Feldman, and Roger Bouillon, all of whom know the importance of the nutrient. Most of this conference is for scientists, not lay people. However, Michael Holick is the first speaker and if you have not heard his latest talk about vitamin D, it might be worth a trip to Germany. The first San Diego speaker was Dr. William Grant. Since leaving NASA to begin a full-time career as a vitamin D researcher, Bill has published dozens of studies and has another dozen in the works. Using ecological studies (from Greek oikos, house + German -logie, study or studying your own house) of UVB irradiance and cancer, Bill reported that 15 cancers (colon, esophageal, gallbladder, gastric, pancreatic, rectal, small intestinal, bladder, kidney, prostate, breast, endometrial, ovarian, Hodgkin's lymphoma, and non-Hodgkin's lymphoma) are associated with lower UVB light. He concluded that 257,000 cancer deaths in 2007 in the USA were accounted for by inadequate vitamin D levels. Of course the problem with ecological studies is that it easy to be vitamin D deficient in Miami, all you have to do is listen to your doctor's advice and stay out of the sun. Recently, a group from the Arizona Cancer Center found almost 80% of Arizonians had levels below 30 ng/ml. So much for sunny spots. Jacobs ET, et al. Vitamin D insufficiency in southern Arizona. Am J Clin Nutr. 2008 Mar;87(3):608-13. The next speaker was Professor Cedric Garland. I found myself wondering how he did it. I became convinced that vitamin D prevents cancer five years ago. Cedric and his brother Frank and his colleague Ed Gorham knew it 30 years ago! I know what it is like to tell someone that vitamin D prevents cancer and see them think, "Here we go again, another miracle vitamin." I know what it is like to try and explain and watch people die unnecessarily. But I've only had that experience for five years. Cedric has dealt with that frustration for thirty years. Almost thirty years ago, Cedric and Frank Garland published evidence that vitamin D prevents cancer. In fact, it was Cedric's first publication. Thankfully, the paper was recently recognized as being so important that it was republished in 2006 by the International Journal of Epidemiology. You can read the entire paper for free by clicking on the second link below and then clicking on "free final text", courtesy of Oxford Journals. Garland CF, Garland FC. Do sunlight and vitamin D reduce the likelihood of colon cancer? Int J Epidemiol. 1980 Sep;9(3):227-31. Garland CF, Garland FC. Do sunlight and vitamin D reduce the likelihood of colon cancer? Int J Epidemiol. 2006 Apr;35(2):217-20. Cedric began by showing the incidence of type-1 diabetes and multiple sclerosis by latitude. I had no idea that the latitudinal data was so strong for type 1 diabetes in children. This disease is almost nonexistent around the equator. Type-1 diabetes is but one of the three modern childhood epidemics caused by the sunlight-hating dermatologists, the other two, I think, are autism and asthma. Next he showed latitude and 25(OH)D levels, which reminded me to be suspicious of high levels, unless they use accurate methods of detecting 25(OH)D. Some methods used, even in this country, are over detecting vitamin D and telling patients their levels are above 50 ng/ml when they are, in reality, much lower. Cedric's data showed Thailand had mean levels of 70 ng/ml, which I doubt and suspect were due to inaccurate 25(OH)D tests. He then reviewed evidence of the 25(OH)D levels needed to prevent numerous cancers. The safest levels are somewhere above 50 ng/ml. Cedric spent most of his time presenting an entirely new theory of carcinogenesis, one dependent on vitamin D maintaining cellular junctions. I suspect this paper will also be reprinted in 20 years. The only disagreement I have is with his recommendation for cancer patients to start at fairly low doses. For reasons I recently explained, the risk benefit analysis indicates cancer patients should take 5,000 to 10,000 IU per day and they may have no time to lose. Why worry about the phantom of vitamin D toxicity if you may be dying of cancer? Just have your calcium checked along with frequent 25(OH)D levels. Get your levels up to 70-90 ng/ml if you have cancer. Vitamin D Newsletter, Does vitamin D treat cancer? The next speaker was Professor Bruce Hollis. He reviewed basic physiology of vitamin D and emphasized that the entire system is designed to deal with an excess not with an insufficiency of vitamin D. Numerous mechanisms are available in your body to prevent vitamin D toxicity but few are available to deal with insufficiency. Then he briefly mentioned one of the most important discoveries about vitamin D in the last few years, one where Professor Neil Binkley of the University of Wisconsin was senior author. (In the last four years, Professor Binkley has become a prolific vitamin D expert and I hope Carol Baggerly is able to get him to speak at some of the upcoming conferences she hopes to sponsor.) As I have pointed out before, Hollis and Binkley's crucial discovery was that the body doesn't start storing the parent compound, cholecalciferol, until 25(OH)D levels reach about 50 ng/ml. They showed, using basic steroid pharmacology, that 50 ng/ml should be considered the lower limit of adequate 25(OH)D levels. Hollis BW, Wagner CL, Drezner MK, Binkley NC. Circulating vitamin D3 and 25-hydroxyvitamin D in humans: An important tool to define adequate nutritional vitamin D status. J Steroid Biochem Mol Biol. 2007 Mar;103(3-5):631-4. Bruce kept the audience enthralled with a review of all the disease states that indicate 25(OH)D levels need to be much higher than they are now, that is, the multiple biomarkers that suggest the lower limit of 25(OH)D levels should be above 40 ng/ml and closer to 50 ng/ml. Then Professor Hollis spoke of his ongoing study in pregnant women and how he got approval to use 4,000 IU of vitamin D per day back in 2003, quite an accomplishment. He also reviewed another one of his research projects, one that answered an age old question, why is breast milk a poor source of vitamin D? How were prehistoric infants supposed to get their vitamin D, by lying out in the sun where saber tooth tigers would eat them? No, they were hidden in caves and had to have another source or the human race would have died out long ago because rickets destroys a woman's and infant's chance to live through childbirth due to rachitic deformations of the mother's pelvis. Carol Wagner and Bruce Hollis, together with their colleagues, answered that age old question, human breast milk is a poor vitamin D source because virtually all modern mothers are vitamin D deficient. That is, when pregnant women keep their levels where we think prehistoric human levels were, about 50 ng/ml, breast milk becomes a rich source of vitamin D. First Carol and Bruce gave 2,000 IU per day, then 4,000 IU per day and finally 6400 IU of D3 per day to lactating women. Only at 6400 of D3/day did the women maintain both their own 25(OH)D levels and the levels of their breast feeding babies above 50 ng/ml. On 6400 IU/day, the vitamin D activity of the breast milk went from about 80 to 800 IU/L. Quite a discovery, and another reason for all of us to keep our levels above 50 ng/ml. Wagner CL, Hulsey TC, Fanning D, Ebeling M, Hollis BW. High-dose vitamin D3 supplementation in a cohort of breastfeeding mothers and their infants: a 6-month follow-up pilot study. Breastfeed Med. 2006 Summer;1(2):59-70. Professor Robert Heaney went last, discussing 74 slides. So much of what we know about vitamin D today is due to Robert's unceasing dedication to vitamin D, the most recent example being his and Joanne Lappe's randomized controlled trial showing that increasing baseline levels from 29 to 38 ng/ml reduced the risk of getting cancer by around 70%. He again pointed out that the body does not begin to consistently store much vitamin D until your levels get to around 50 ng/ml. He also went through multiple biomarkers of vitamin D. That is, what level or intakes do you have to have to reduce the incidence of multiple diseases? He covered calcium absorption, osteoporosis, risk of falling, muscle function, death and disability of the aged, TB, influenza, cardiovascular disease, hypertension, diabetes, cancer, multiple sclerosis, and gum disease. How can one vitamin be involved in so many diseases? Simple said Dr. Heaney, "vitamin D is the key that unlocks the DNA library." He then reviewed toxicity and concluded there is no evidence that it occurs at levels below 200 ng/ml or with intakes (total) below 30,000 IU per day. Of course, we have no reason to think anyone needs 30,000 IU per day or levels of 200 ng/ml, which would be irresponsible. But someone with a serious cancer should consider getting their level up to 70-90 ng/ml and that may take 10,000 IU per day or even more in some people. As a rule of thumb, 1,000 IU will raise 25(OH)D levels by about 10 ng/ml. Then Professor Heaney addressed a public health question. How much would we have to give all Americans to get 98% of people above 32 ng/ml without causing toxicity in anybody? The answer: 2,000 IU per day. Of course 32 ng/ml is not adequate but it would be a great first step. Furthermore, of the people left out, a high percentage would be African Americans. In fact, Dr. Talwar recently reported that 40% of African American women fail to achieve a level of 30 ng/ml even after taking 2,000 IU/day for a year. Talwar SA, Aloia JF, Pollack S, Yeh JK. Dose response to vitamin D supplementation among postmenopausal African American women. Am J Clin Nutr. 2007 Dec;86(6):1657-62. He also discussed his recent study giving healthy adults 100,000 IU as a single dose. If you start with a baseline level of 28 ng/ml and take 100,000 IU as a single dose, mean levels will remain above 32 ng/ml for two months. If you rely on such stoss doses, but you start with a lower level, or want your levels above 50 ng/ml, how often do you need to take 100,000 IU? We don't know the answer to the last question but we know that Grey et al gave 50,000 IU per week for four weeks then 50,000 per month for a year to 21 patients with hyperparathyroidism. Blood levels rose from a mean of 11 ng/ml at baseline to 30 ng/ml at one year and levels did not continue to rise after six months. Remember, that means half the patients had levels lower than 30 ng/ml at the end of the year. Also remember that the metabolic clearance (how quickly you use it up) might be higher in certain disease states. Grey A, et al. Vitamin D repletion in patients with primary hyperparathyroidism and coexistent vitamin D insufficiency. J Clin Endocrinol Metab. 2005 Apr;90(4):2122-6. That last point, metabolic clearance, is only one of a number of reasons that patients vary in their response to vitamin D. Remember, a surprising number of patients will tell their physician they are taking vitamin D when they are not, some will be taking preparations that have less in it than the label says, some will not absorb it, and some people weigh more than others. As Dr. Heaney points out, even if you know patients took 100,000 IU, great variably exists in individual response. At the end of two months some will have shown a minimal response and other much more. This is a field where little is known. Do different disease states use up vitamin D quickly? The answer is probably yes. Furthermore, variability also exists in how one metabolizes and catabolizes (breaks down) vitamin D. Also, what is the interactive effect of drugs that use the same liver enzymes for catabolism? We just don't know and that is why vitamin D blood testing is crucial. Remember, the only test to have is a 25-hydroxy-vitamin D. Do not let anyone get a 1,25-dihydroxy-vitamin D; it will not tell you if you are vitamin D deficient and is usually only indicated in evaluating high blood calcium. As far as 25(OH)D levels go, many of you have written complaining about the high cost of a 25(OH)D levels at some labs. I've got some good news. For the next month, Life Extension Foundation is having a sale on their 25(OH)D blood tests, only $32.25, including the fee for drawing the blood. (No, we don't get funding from Life Extension, I wish we did.) Life Extension uses LabCorp, which, in turn, uses an accurate method to determine 25(OH)D levels, the DiaSorin Laiason method. The only problem is that DiaSorin, LabCorp, and Life Extension all say that 30 ng/ml is acceptable. It is not. Take enough vitamin D or get enough UVB radiation to get your levels above 50 ng/ml. To order the test, call Life Extension at 800'208-3444. Unfortunately, this offer is not available in New York, New Jersey or Rhode Island. Also, Dr. James Dowd has written a fine book about vitamin D, The Vitamin D Cure. Get this, he is board certified in internal medicine, adult rheumatology, and pediatric rheumatology, an associate professor at Michigan State University, and runs his own Arthritis Institute and the Michigan Arthritis Research Center. He gives a formula for how much vitamin D you need but stresses the importance of testing to know for sure. He uses the formula of 2000 IU for every 100 pounds of body weight, which is as accurate an estimation as one can make without knowing baseline levels. Of course it depends on so many things, as Dr. Dowd points out, such as percentage body fat, latitude, skin type, sun exposure and age. He gives case after case examples of how vitamin D not just prevents disease, but seems to have a treatment effect. He also stresses three other things I've written about before, acid base balance, magnesium and potassium. If you can't get eat enough fruits and green leafy vegetables to obtain your potassium and magnesium and to get rid of low-grade chronic metabolic acidosis, then you should consider magnesium supplements and potassium bicarbonate supplements. With these four experts and with this month's vitamin D news articles about breast cancer, brain function, artery blockage in the legs, soft skulls in babies, peripheral neuropathy in diabetics, childhood type-1 diabetes, colon cancer, and stress fractures and with the increasing number of scientists around the world jumping on the vitamin D express, why doesn't the government do something? What will it take? Like Carole says it will take a grassroots effort. The first thing to do is tell your family and friends about vitamin D. Tell your doctor. Get your family's 25(OH)D tested, including your children. Once people begin to see it works, they will get their family and friends to take it. They will feel better and then the word will spread. All the government can do is make vitamin D illegal or limit the amount in each pill. The first is unlikely but not the second. With 5,000 IU capsules widely available, many people give no thought to taking one a day. But if the government limits the sale of anything over 400 IU and people had to take 12 of the 400 IU tablets, instead of one of the 5,000 IU, they might balk at so many pills. Before our officials in Washington take such a step, let's hope they read the Washington Post.
John Cannell, MD
The Vitamin D Council
This is a periodic newsletter from the Vitamin D Council, a non-profit trying to end the epidemic of vitamin D deficiency. This newsletter is not copyrighted. Please reproduce it and post it on Internet sites. We are a nonprofit tax-exempt educational organization and depend on your donations.
The Vitamin D Council
9100 San Gregorio road
I read the information on your site about fibromyalgia and flouride poisoning but I didn't find any on the link between Vit. D deficiency and fibro. I just want to be sure that those suffering from this illness are aware of the belief that fibro. is considered by some to be an adult form of rickets. It manifests itself with signs of so many symptoms because if the body is deficient in Vit. D then it will become deficient in all of the minerals the body needs because without the vit. D in the colon minerals cannot be utilized and absorbed by the body. There is no substitute for the natural vit. D produced by the body by being exposed to natural sunlight....especially women are deficient because all of their makeup and body lotions block the UV rays of the sun. If you are suffering from fibromyalgia, please research the link between fibro. and vit. D deficiency.
I have a real interest in understanding why so many people around the world are deficient in Vitamin D. Would anyone like to chime in on this critical health problem?
I am not deficient but every other person I meet who has had their labs done, are terribly deficient.
(Ten Mile , Tn)
Vit. D(3) is not a vitamin but a hormone. There are 4 ways to get vitamin (hormone) d3:
#1 sun, #2 veggies, #3 fish oils like salmon, codliver, sardines #4 made from lanolin, which includes sprays, liquids, lotions, pills and mouse poison.
One must be very careful taking d3 as it stays in the liver for 3 months, causes the blood to thin, and allows the calcium to get into the blood stream causing clogged arteries, calcium to deposit anywhere it wishes. Look it up.
(Ten Mile, Tn Usa, Tn Usa)
I was having multiple hot flashes and also not sleeping well. My blood work said I was deficeint in Vitamin D. Since I started supplementing four weeks ago I am now sleeping and the hot flashes have been cut in half. Is this a coincidence?
WHICH IS THE BEST FORM OF D? D2 ERGOCALCIFEROL OR D3 CHOLECIFEROL
AND B3 NIACIN? NIACINAMIDE OR NICOTINIC ACID
I use apple cider vinegar for my hypertension. I love trader Joes but also have used braggs. I can honestly say I have drank over the past 3 years a more than a hundred bottles. I buy at least 10 to 12 bottles from trader joes at over two dollars a bottle not that expensive. Apple cider vingar works with my blood pressure I had a bp of 200/120 apple cider vinegar just one dose dropped it down to 170/100 still extremely high. Now I am 6 foot 3 280 lbs and need to loose weight bad. I still take apple cider vinegar 4 tablespoonfuls once a day. I should do it a least twice but I don't and probably add some raw garlic. As I am athletic run two miles swim a mile and play sports. I am overly stress work the night shift and around obese people.
However vitamin d has worked better for me than apple cider vinegar. I take 5000 iu daily with magnesium 400mg and One a day vitamin for men. Vitamin D helps my immune system hypertension and regulates my insulin all at the same time. This vitamin D 3 works. Please check out vitamindcouncil.org. Most americans do not get enough vitamin d because we are always in doors. It is really cheap at whole foods trader joes walmart even dollar general. Please Please add vitamin d3 to your daily routine you will feel and see the difference.