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Newsletter: Ignored facts

Posted on: October 2, 2005   by  John Cannell, MD

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I love ignored facts. Aldous Huxley once said, “Facts don’t cease to exist just because they are ignored.” I decided to look for ignored facts. Were there any ignored facts that would tell me how to protect my three-year-old from the infection-of-the week from her day-care center? Tucked away in an ignored journal was an ignored fact.

In 1994, Dr. Rehman gave 60,000 units of vitamin D a week to 27 children (aged 3-12) with frequent childhood infections and compared them to controls. The children also had elevated alkaline phosphatase (like many American children), which usually indicates vitamin D deficiency. He gave the kids vitamin D for six weeks along with calcium. He didn’t say if he used real vitamin D (cholecalciferol) or if he used ergocalciferol. Anyway, he gave them 60,000 units a week for six weeks, about 9,000 units a day.

Rehman PK. Sub-clinical rickets and recurrent infection. J Trop Pediatr. 1994.

Within a few weeks, “infections were fully controlled and no recurrences were reported for six months.” The kids just stopped getting sick! An ignored study, ignored facts, not repeated, not remembered. The author didn’t measure vitamin D levels, but 9,000 units a day of vitamin D for six weeks should bring most vitamin D deficient children to 50 ng/ml, probably higher.

I’m skeptical by nature. So I decided to experiment on myself – physicians experimenting on themselves are one of the great traditions in medicine. I bought some 50,000 unit capsules of real vitamin D from Bio-Tech. The next time I got the crud, I took a single capsule (50,000 units) of cholecalciferol, which is perfectly safe for adults. In Europe, they give ten times that amount as “stoss therapy” all the time. I was amazed how much better I felt the next day. If you decide to experiment on yourself, do it once or twice. Don’t keep taking 50,000 units every day or you will get toxic. Also, keep close tabs on your vitamin D level.

Children don’t need the 60,000 units a week to improve their immune system, although Dr. Rehman found that amount safe for six weeks. 60,000 units per week for a young child is a pharmacological dose, not a physiological dose. If vitamin D could be patented, we would already have lots of studies using pharmacological doses as drug companies explored dosage ranges to find the maximal effects of vitamin D. However, it can’t be patented and studies using pharmacological doses are decades away.

For now, vitamin D deficiency is easily treated with physiological doses. More to the point, you probably know someone dying of vitamin D deficiency. Lawyers may be interested in knowing that most oncologists in this country – in spite of what is known about vitamin D and cancer – let their cancer patients die vitamin D deficient. A group of scientists got together last week in San Diego and looked at the issue. I liked Professor Garland’s conclusion: “Almost no one is being made sick by Vitamin D toxicity, but literally millions are dying from Vitamin D deficiency.”

Not only do we have no studies using pharmacological doses, we are still waiting for additional studies using physiological doses (2,000 to 10,000 units a day). Vieths’ studies showing that 4,000 units of cholecalciferol a day helped depression, and that 2,000 units a day stopped PSA increases in the majority of men with prostate cancer, are two of the few.

Vieth R, et al. Randomized comparison of the effects of the vitamin D3 adequate intake versus 100 mcg (4000 IU) per day on biochemical responses and the wellbeing of patients. Nutr J. 2004.

Woo TC, et al. Pilot study: potential role of vitamin D (Cholecalciferol) in patients with PSA relapse after definitive therapy. Nutr Cancer. 2005.

By the way, the government says 2,000 units a day are safe for children over one year of age. In fact, 1,000 units a day will give most young children normal vitamin D levels. Children who weigh more than 60 pounds may need 2,000 units a day to obtain normal levels (50 ng/ml). It is unlikely vitamin D prevents infection, it probably just calms our immune system, especially our macrophages, our internal Pac-Men that keep zapping the invaders – and our insides – with oxidative bursts until something tells them to stop. Along those lines, Drs. Laura Helming, Andreas Lengeling, and their German colleagues announced an important discovery last month. They discovered that vitamin D does indeed tell the Pac-Men to stop; otherwise those oxidative bursts can cause autoimmune illness.

Helming L, et al. 1alpha,25-Dihydroxyvitamin D3 is a potent suppressor of interferon gamma-mediated macrophage activation. Blood. 2005.

The Germans explained why autoimmune illness is so common in vitamin D deficient patients. Without enough vitamin D, the immune system can’t make enough activated vitamin D to tell macrophages enough already. The authors concluded their discovery “might be an important mechanism to prevent uncontrolled and excessive reactions in local inflammatory environments . . . Since macrophages play important roles in several autoimmune diseases, this may be of special clinical importance.” Way to go Germany. If you have an autoimmune illness, take enough real vitamin D (cholecalciferol) to get your level to about 50 ng/ml. Keep it at 50 ng/ml year around. For most adults, that means about 4,000 units a day, a little more in the winter and less in the summer, depending on sun exposure. Big people need more than little people. African Americans need more than whites. Sunphobes need more than those who enjoy God’s invention. No one knows if pharmacological doses would effectively treat autoimmune disease.

Of course, it is a good idea to keep your level around 50 ng/ml, even if you don’t have autoimmune illness. Professor Bruce Hollis points out that 50 ng/ml is close to the normal human level.

Hollis BW. Circulating 25-hydroxyvitamin D levels indicative of vitamin D sufficiency: implications for establishing a new effective dietary intake recommendation for vitamin D. J Nutr. 2005.

Bruce is one of the few scientists who saw vitamin D clearly 20 years ago. Down at the Medical University of South Carolina, he is making sure pregnant women get around 4,000 units of real vitamin D a day. He and Carol Wagner were the ones that discovered most human breast milk doesn’t contain vitamin D for a very good reason: most human mothers are vitamin D deficient, a major discovery. We can only hope that widespread vitamin D maternal deficiency doesn’t cause birth defects in baby brains like it does rat brains. If it does, it won’t be the children whose mothers were under Dr. Hollis’ care.

If you know anyone who is pregnant, make sure she sunbathes a few minutes around noon every day in the late spring, summer and early fall and uses a sunlamp the rest of the time. Alternatively, pregnant women could take enough real vitamin D (cholecalciferol) to obtain normal human vitamin D levels of around 50 ng/ml. Their child may be at risk if they don’t keep normal levels. The sun and sunlamps are easier for pregnant women because their bodies will optimize levels and neither they nor their obstetricians have to worry about the pills.

Two Austrians, Meinrad Peterlik and Heidi Cross, had a great review several months ago of all the diseases associated with vitamin D and calcium deficiency. Vitamin D and calcium go together. Vitamin D can’t do what it needs to do without adequate calcium. The Austrians concluded, “Hypovitaminosis D is a widespread phenomenon in the adult population of Central and Western Europe as well as in North America . . . and an important public health problem because of numerous implications for the development of common diseases.”

They reviewed the evidence that deficiencies contribute to colon cancer, breast cancer, prostate cancer, diabetes, metabolic syndrome, hypertension, infectious disease, inflammatory bowel disease, rheumatoid arthritis, lupus, and MS. When calcium and vitamin D deficiencies were combined, they found only 11% of the population had adequate intakes/levels of both. That is, 89% of us are deficient in one or the other or both. I know Heidi from vitamin D conferences; she’s a good scientist.

Peterlik M, Cross HS. Vitamin D and calcium deficits predispose for multiple chronic diseases. Eur J Clin Invest. 2005.

When combined with other recent papers, the point is: take enough real vitamin D (about 4,000 units of cholecalciferol per day for adults) to maintain vitamin D levels of around 50 ng/ml and make sure you get at least 1,000 mg of calcium every day.

Want some more ignored facts? In 1969, Voors and Johnson looked at mortality from heart disease in the largest cities in the United States and discovered the higher you live, the less likely you were to die from heart disease.1 Several of the cities at highest altitude had about half the deaths of sea level cities. This is consistent with Leaf’s 1973 finding that long-lived communities are all at high altitude, where UVB light makes a lot more vitamin D.2  By the way, Italian researchers found strong seasonal variations in blood clots and, you guessed it, clots are much less common in the summer, when vitamin D levels are higher.3 These correlations with heart disease and blood clots are probably not strong in the USA these days, as American dermatologists have sun-scared the people in Denver as well as New York.  Maybe folks are smarter in Italy.

Again, the take-away point is to get your vitamin D blood level (25-hydroxy-vitamin D) up to about 50 ng/ml and keep it there year around. About 4,000 units of cholecalciferol every day should do it. I’d take more if I had cancer or heart disease or autoimmune disease (enough to get my level up to 60 ng/ml year around) but there are no studies to prove that’s a good idea. If you have a serious illness, you can read the current literature and decide for yourself, or you can die waiting for definitive interventional studies.

How much does vitamin D deficiency cost, besides the millions of lives? Three other good scientists, Bill Grant, Cedric Garland, and Michael Holick, recently attempted to answer that question. They came up with a figure of about 40 to 60 billion dollars every year in the USA alone. I think that is a conservative number.

Grant WB, et al. Comparisons of estimated economic burdens due to insufficient solar ultraviolet irradiance and vitamin D and excess solar UV irradiance for the United States. Photochem Photobiol. 2005.

Also, check out Dr. Grant’s organization, SunArc. Bill was a NASA scientist until he retired and started his own non-profit to do research into vitamin D. He is doing just that and making a difference.

No, facts don’t cease to exist because they are ignored. But they make little difference when policy advisors, like the Institute of Medicine, ignore scientific facts. The Institute recommends 400 units a day, instead of 4,000. They are making a full order of magnitude error; millions of people are dying needlessly, especially African Americans. E-mail Dr. Harvey Fineberg, President of the Institute of Medicine: [email protected] Ask him to stop ignoring the facts.

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