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Dear Dr Cannell: Vitamin D, nutrition and bone health

Posted on: October 13, 2011   by  John Cannell, MD

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Dear Dr. Cannell:

I am a long-time reader and supporter (and proselytizer) for vitamin D council, and I have a question I hope Dr. Cannell will address in his newsletter, as it affects so many women.

I take enough vitamin D — usually about 4000 – 5000 IU/day in the winter, and 1200 – 2000 IU in summer — to keep my level at about 50. I also take around 1000 mg of calcium. However, my recent bone scan showed that my osteopenia had increased significantly over my last test, around 2006.

I’ve read that too much Vitamin D, in relation to calcium, can actually leach calcium from bones and increase the risk of osteoporosis? Can you talk about the right balance of Vitamin D, calcium and magnesium needed by older women, and how needs vary by weight? I’m 53, 5′ tall and 105 lbs. — I understand small, thin older women like myself are more prone to osteoporosis than our larger sisters.

Another question is how much vitamin D is safe to take over the short term, when fighting a cold or flu. When I feel a cold coming on, I’ll take 50,000 IU for up to a week, and I’ve advised my family to do the same. When my daughter, who is 18 years old, 5’5″ and about 115 lbs was sick recently with the flu, she was mistakenly taking 100,000 IU daily — but it was effective! When I told her to cut back to 50,000, her symptoms returned and she relapsed.

Thanks for any advice you can give. I do hope to see the osteoporosis/osteopenia question addressed on the website, blog or newsletter.

Tory Michaels

Dear Tory:

http://www.womentowomen.com/bonehealth/naturalbonehealth.aspx?id=19&campaignno=osteoinfo&adgroup=ag1general&keywords=osteoporosis

Please see the above website. Osteoporosis also involves vitamin K, zinc and boron, seeds and nuts, dairy products (a better source of calcium than pills), acid-base balance, sunlight, and bio-identical hormones (although these may increase the risk of breast cancer). I am concerned that calcium may be taken from bones with 25(OH)D levels above 100 ng/ml by the mechanism you explain.

However, low-grade systemic metabolic acidosis, bathing your bones in acid all your life, is probably a big contributor to osteoporosis. Ask your doctor for a prescription of 25 meq of potassium bicarbonate. 25 meq of potassium bicarbonate dissolved in water twice a day will help prevent such acidosis, as will a diet rich in vegetables. Vinegar is also helpful to alkanalyze your body in spite of it being an acetic acid. The above website explains it.

I can’t explain why 100,000/day was effective in your daughter but 50,000 IU/day was not. A level of 50 ng/ml should afford significant protection against those infections sensitive to vitamin D.

 

Dear Dr. Cannell:

I am an intensive care nurse from Canada. In June of 2010, I also had the misfortune of having my son taken away from me (me and my loving husband) right in the hospital where I work as he was found to have numerous fractures in different stages of healing. He also had an intra-cranial hemorrhage and retinal hemorrhages. I am sure you have heard this story repeatedly by now. My son had 12 rib fractures, as well tibia and femur fractures… all asymptomatic without bruises, internal injury, swelling, redness etc. Different medical professionals saw him numerous times in the first 8 wks. of his life and there was never a concern of fractures.

I was fortunate to find experts like, Dr. Charles Hyman, Dr. Pat Barnes, Dr. Julie Mack, Dr. Waney Squier to review my case in a thorough manner. It was concluded my son had superficial cortical venous thrombosis and the fractures most likely due to vitamin D deficiency. I feel somehow these anomalies are related.

During my pregnancy, I had horrible gingivitis; in fact I went twice to the dentist with these complaints as I had a space develop between my two front teeth because my gums were so badly inflamed. I had frequent nosebleeds, and very brittle and cracked fingernails. My pregnancy books could validate all of these symptoms.

My pregnancy was slightly complicated when my son presented in the breech position and would not turn. I had very limited fetal movement. I can confirm that my son was in this position for at least 8 weeks prior to delivery as evidenced by sequential ultrasounds. In this position he was not able to use his legs/ and kick as the typical fetus does. I suspect this along with a low vitamin D level was responsible for his asymptomatic fractures and brittle bones (emphasis given that I was pregnant during the winter season and I exercised routinely during my pregnancy).

In my case however, I only breastfed for 4 days, then after it was 2/3 formula and 1/3 breast milk for 1 month, and thereafter strictly formula. It wasn’t until my son’s first birthday that i was able to get a vitamin D level checked at his doctor’s apt. That level was taken when my son had been receiving vitamin D drops 400 IU in addition to his formula. The level was 18 ng/ml (normal for the lab was 30- 100 ng/ml). So now we are doubling his vitamin D dose.

During the first year of my son’s life, he continued to present with popping and cracking noises in his chest/back, shoulders and hips (although when the doctors did a hip click test, they never popped). He also had prominent flattening of the right side of his head. My pediatrician suggested he might need to wear a helmet for this. Now the popping isn’t as bad as it used to be (he is 17 months almost). His head shape has improved remarkably also (he never ended up wearing a helmet).

I was wondering if my son is still in low range of vitamin D despite formula + supplement, would that not be reflective of a marked deficiency at birth?

There has to be a link to bleeding/clotting deformations and bone deformations.

My nightmare with child protection is ongoing.

June Smith

Dear June:

He needs 2,000 IU/day, not 800. I agree there must be a link between bleeding and vitamin D deficiency but no one has studied it yet. For example, many babies have retinal hemorrhages and the incidence of such hemorrhages is seasonal, with the highest incidence in the winter. Some have claimed this is due to the lack of vitamin K containing vegetables in the winter but that is clearly no longer the case as we have green vegetables year around now. Did he have an injection of vitamin K at birth? I would give him vitamin K as a supplement.

I’m glad you could get such good forensic experts. Many mothers cannot and end up losing their most precious possession.

3 Responses to Dear Dr Cannell: Vitamin D, nutrition and bone health

  1. JBG

    “Osteoporosis also involves vitamin K, zinc and boron…”

    Many, perhaps most, discussions of vitamin K do not make clear that there are two forms of vitamin K, quite different from each other, and that the distinction is consequential. For the letter writer, I’ll add a few remarks about the matter here.

    Vitamin K1 is readily available from green vegetables and rarely deficient in Americans after infancy; vitamin K2, is largely absent from the modern American diet and deficiency is widespread, perhaps the rule. They are related in that a small amount of K1 can be converted in the body to K2.

    K1 is important for blood clotting. K2 is crucial for the body’s handling of calcium, routing it TO the bones/teeth, and routing it AWAY from the blood vessels and soft tissues. If you have osteoporosis-related issues, you may well have cardiovascular issues as well.

    In earlier times (fifty years ago and earlier), meat and dairy provided reasonable amounts of K2. Modern commercial meat/dairy production, which feeds cows mostly on grains/soy rather than on grass, has pretty well done away with that source. Unfortunately, grass-fed meat is hard to find and expensive. Those with access to a good health store may be able to find a specific form of Organic Valley butter, or they may be able to find imported Kerry Gold butter, both of which are rich in K2. Certain cheeses are said to be rich in K2, and also a Japanese fermented soy product called natto. Thorne makes a reliable supplement; other supplements may be regarded with caution in my opinion.

    The Susan Brown website recommended above is excellent and provides copious useful information about natural approaches to osteoporosis.

  2. JBG

    I hasten to add that Dr. Cannell knows — way better than me — about the things discussed in my earlier comment. I hope I’ve saved him some trouble by writing it out here.

    Also, if there is a K2 supplement he recommends, I’m sure it’s fine. K2 has been much on my mind for a while, and my comment on K2 supplements is based on investigating I did some time ago.

  3. jelarsen1@cox.net

    The entire system is backwards. We focus on dosages as if all were identical. The USDA/FDA/IOM should publish target serum levels, best technical measurement approach, and all appropriate caveats. For D, for example, over 50, dark skin, obesity, co-factors, etc. affect dosing.

    Dosing blindly is highly inaccurate. Dosages can be a U shaped curve. Too little can be ineffective and too much can be harmful. Test then treat. Goldilocks was right. Every year folks die from drinking too much water (hyonatremia).

    Bones are living tissue (sort of like slow growing muscles) that need 20 nutrients, impact exercise, and an alkaline serum level. Remember bones make your RBCs.
    http://www.betterbones.com/bonenutrition/20keybonenutrients.aspx
    http://www.betterbones.com/bonehealth/bonebreakdowntests.aspx

    Supplemental calcium (remember the RDA are gender and age averages that reflect total daily intake) will only help calcium deficient folks. Athletes might need 2x the RDA. Assuming adequate serum levels, only exercise makes bones stronger.

    The good news is folks can buy tests directly at bargain prices. http://www.scribd.com/doc/33720083/Bio-Clarity-Sample
    http://www.directlabs.com They call this the Interpretive Report

    You might also want to look at green tea and dried plums; they appear to help strengthen bones as well.

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