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The Vitamin D Newsletter November 2006

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"Gilchrest Fractures"

Vitamin D, Atherosclerosis, and Influenza

Before I answer reader's questions, I want to alert readers to this month's groundbreaking study about atherosclerosis and vitamin D. Atherosclerosis is the disease process that leads to heart attacks and strokes. Dr. Targher and his group in Italy measured the amount of atherosclerotic plaque (carotid artery intimal thickness) and the vitamin D levels of 390 diabetic patients. The authors found low vitamin D blood levels were an independent and strong predicator of atherosclerosis. Professor Robert Scragg of the University of Auckland was right 16 years ago, when he discovered that low vitamin D levels are associated with heart attacks. Targher G, et al. Serum 25-hydroxy vitamin D3 concentrations and carotid artery intima-media thickness among type 2 diabetic patients. Clin Endocrinol (Oxf). 2006 Nov;65(5):593–597. Scragg R, et al. Myocardial infarction is inversely associated with plasma 25-hydroxy vitamin D3 levels: a community-based study. Int J Epidemiol. 1990 Sep;19(3):559–63.

The flu season is just around the corner—I recommend that you take enough vitamin D this winter to keep your vitamin D level, also known as 25(OH)D, between 50–80 ng/ml (125–200 nmol/L). For many people that means 5,000 IU per day in the winter. If you do, our hypothesis predicts that you will not be as likely to get viral respiratory infections, and if you do get sick, it will not be as severe. The vitamin D theory of influenza has two important strengths. It is parsimonious, that is, it explains many observations with a single mechanism. Most importantly, if our theory is false, it can easily be disproved. Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant WB, Madronich S, Garland CF, Giovannucci E. Epidemic influenza and vitamin D. Epidemiol Infect. 2006 Dec;134(6):1129–40.

You can test the theory in another way. Simply obtain a bottle of 50,000 IU capsules of vitamin D3. Wait until you are sure you are getting a cold or the flu. Then take 1,000 IU of vitamin D per pound of body weight every day for three days. For a 150 pound adult, that would be 150,000 IU (three capsules) a day for three days. This is called "stoss" therapy in Europe and is safe to do, unless your have a high blood calcium for any reason. Remember, bottles of 50,000 IU vitamin D are a medicine, not a supplement, and you will make yourself vitamin D toxic, and you may even die, if you take a 50,000 IU capsule every day for months or years.

Vitamin D and Obesity

Dr. Cannell: I am a Seventh-Day Adventist missionary and work in the poorest parts of West Oakland. I take 4,000 IU of vitamin D every day and sit in the sun (arms and face exposed) most days for fifteen minutes at noon. It has cured my gum disease and I can run again full blast after not being able to run a step for four years.

I have been handing out vitamin D for two years as a first response to people with severe auto-immune diseases. There's no blood testing, no opportunity for quality medical care, no one to fall back on in this third-world climate. I just educate people as best I can about the advantages of vitamin D and give them a bottle of Carlson's 2000 IU vitamin D with instructions to take twenty to start and then two a day for the rest of their life. The results have been pretty spectacular, especially with people who have arthritis or diabetes.

One unexpected result was that many people are losing weight, twenty, thirty, forty pounds, spontaneously, and they look great, too. One of these individuals taking 4,000 asked me if vitamin D made you lose weight. She is very obese but had rather abruptly lost 20 pounds. Now, a month later, she has lost a total of 32 pounds and is delighted. I can assure you based on results here that many people who are obese are most certainly losing weight on vitamin D.

One sad note is an individual who weighs at least 300 pounds at 57. He's very strong and hearty, a VA community-based psychiatric patient with other health problems. I gave him a couple bottles of vitamin D and he lost considerable weight, fifty or sixty pounds. It didn't occur to me at the time that the weight loss could be linked to the D, but I'm almost certain that was the cause. Then he told his VA doctor that he was taking vitamin D and the doctor went nuts, told him it was toxic, and told him to never take it—which is where things are today—and he rapidly gained back all the weight. In my experience, most doctors don't know anything about vitamin D except that it's potentially toxic. Keep up your good work! George Oakland, California

I suspect that physiological doses of vitamin D (5,000 IU per day), will induce weight loss in obese vitamin D deficient patients. I reviewed the reasons in a newsletter (PDF format) several years ago. At this point, it would be best if these patients had periodic vitamin D blood levels, especially if they stay on these doses for years. Another thing, in the summer, especially when you sit in the sun, you should not take any oral vitamin D. Yes, physicians know very little about the recent vitamin D research and they won't until the lawsuits start. Keep up your good work.

Sun Important For Children's Health

Dr. Cannell: I have always been very protective of my children's health. I made sure they ate right, went to bed on time, and always wore sunblock. A few weeks ago, my 16 year old computer whiz son decided to start jogging instead of playing computer games all weekend. The very first day he came home with his right foot hurting and the doctor said the x-ray showed he had broken a bone in his foot, a "stress fracture," from jogging! He didn't step on anything or twist his ankle, it just broke for no reason. The doctor told him he should drink more milk but he drinks plenty of milk. What could have caused this? April Duluth, Minnesota

Your son had what I call a "Gilchrest fracture." About 30 years ago, dermatologists like Barbara Gilchrest at Boston University, began telling Americans, including children, to stay out of the sun, lather on the sunblock, and to "drink milk" if they are concerned about vitamin D. The problem is that your son would have to drink at least 40 glasses of milk a day to get enough vitamin D if he followed her sun-avoidance advice and it sounds like he did.

Gilchrest fractures are vitamin D deficiency fractures in healthy people that occur after normal activities. Two studies have clearly linked such fractures to low vitamin D levels. A recent Finnish study found Gilchrest fractures to be almost four times more likely in young soldiers with vitamin D levels below 30 ng/ml (75 nmol/L). An earlier study of Israeli soldiers showed the same thing. The surprising thing about both studies was none of the men were obviously vitamin D deficient, indicating—once again—that current lower limits of vitamin D blood levels are set too low and that serum 25(OH)D levels should be maintained at 50–80 ng/ml (125–200 nmol/L), year-round. Ruohola JP, et al. Association between serum 25(OH)D concentrations and bone stress fractures in Finnish young men. J Bone Miner Res. 2006 Sep;21(9):1483–8. Givon U, et al. Stress fractures in the Israeli defense forces from 1995 to 1996. Clin Orthop Relat Res. 2000 Apr;(373):227–32.

The rates of Gilchrest fractures, even in young people, have been steadily increasing over the last thirty years, since dermatologists have been handing out their pathological advice. For example, the incidence of fractured wrists in American kids went up 32% in boys and 56% in girls between the years 1970–2000. Khosla S, et al. Incidence of childhood distal forearm fractures over 30 years: a population-based study. JAMA. 2003 Sep 17;290(11):1479–85.

A study in Great Britain showed a clear latitudinal variation with the lowest fracture rates in sunnier southeast England and the highest rates in of Gilchrest fractures in Northern Ireland, Wales, and Scotland. Cooper C, et al. Epidemiology of childhood fractures in Britain: a study using the general practice research database. J Bone Miner Res. 2004 Dec;19(12):1976–81.

The good news is that your son only suffered a broken foot by following Professor Gilchrest's advice. As you will see below, others have lost their lives.

Flu Shots

Dr. Cannell: I'm 75, and live at home. Should I get a flu shot? Most of my friends get a flu shot. If I get a flu shot, will it protect me from getting the flu? Susan Washington, D.C.

Yes, you should and no, it does not. Although flu shots don't prevent the flu in elderly people living in the community, they do appear to reduce your risk of dying or from being hospitalized. Jefferson T, et al. Efficacy and effectiveness of influenza vaccines in elderly people: a systematic review. Lancet. 2005 Oct 1;366(9492):1165–74.

For ethical reasons, it is difficult to conduct a truly random interventional study, that is, it is difficult to take a large group of well-matched elderly people and deny half of them a flu shot while giving the other half a flu shot and then see who dies. Influenza-associated deaths in the United States more than doubled between 1976–1999, and 90% of those deaths were in patients 65 years and older, a trend that can only be partially explained by the aging population. If flu shots are effective, and if more and more older Americans have been getting them, why have more and more older American been dying of the flu? Thompson WW, et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003;289:179–86.

One possibility is that flu shots do help, but vitamin D deficiency promotes influenza more than flu shots prevent it. And, as more and more older Americans follow Dr. Gilchrest's advice to stay out of the sun, more and more older Americans become vitamin D deficient and then die from influenza, in spite of their flu shot.

Sunlight Reduces Cancer

Dr. Cannell: My mother died of breast cancer and my sister has had it for two years. Now I have it. How much vitamin D should I take? Shannon Boston, Massachusetts

As I've said before, if I had cancer, I'd take at least 5,000 IU of vitamin D every day in the colder months. In the warmer months, I'd stop the vitamin D and get a safe amount of noontime sunshine. I'd keep my 25-hydroxy vitamin D levels between 50–80 ng/mL, year around. However, I do that now and I've not been diagnosed with cancer. Several recent studies are relevant to breast cancer. Dr. Carlo Palmieri, and his group from the Imperial College in London, found that women with early stage breast cancer had higher vitamin D blood levels than women with more advanced cancers. Palmieri C, et al. Serum 25 hydroxy vitamin D levels in early and advanced breast cancer. J Clin Pathol. 2006 Oct 17;

Even more important was the third study reported to date, this time by Dr. Lim at the King's College in London, showing improved survival when cancer is diagnosed in sunnier months. Studies of season of diagnosis and cancer survival are very important because they imply a treatment effect from higher vitamin D blood levels. Lim HS, et al. Cancer survival is dependent on season of diagnosis and sunlight exposure. Int J Cancer. 2006 Oct 1;119(7):1530–6.

In terms of sunlight and cancer incidence, a recent literature review found 94 studies. The authors threw out 67 of the papers for not meeting their strict criteria, although every one of the discarded papers looking at the big three (prostate cancer, breast cancer, and colon cancer) showed sunlight reduces cancer. Of the remaining 27 papers, 8 of 8 prostate cancer papers, 7 of 7 breast cancer papers, and 5 of 6 colon cancer papers showed sunlight prevented cancer. The authors concluded, "There is increasing and conclusive evidence that sunlight has a preventative effect on the initiation and/or progression of prostate and breast cancer, colon and possibly also ovarian cancer." Someone needs to tell that to Professor Gilchrest. van der Rhee HJ, et al. Does sunlight prevent cancer? A systematic review. Eur J Cancer. 2006 Sep;42(14):2222–32.

All this leaves us with a question, "Are physicians responsible for their advice?" When dermatologists or other physicians subvert the vitamin D steroid hormone system by telling patients to avoid the sun, do they assume an affirmative duty to assess and maintain the vitamin D system they have subverted? Do they have a duty to inform their patients about relevant risks of sun-avoidance? Do they have a duty to inform their patients about relevant risks of vitamin D deficiency? How many dermatologists even bother to check vitamin D levels in their pale-as-ghost patients? How many bother to advise vitamin D supplements? If they do advise supplements, how many advise enough vitamin D to compensate for lack of sunlight? These are questions for tort lawyers.

Remember, we are a non-profit and rely on your donations to publish our newsletter, maintain our website, and pursue our objectives. Send your tax-deductible contributions to:

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John Jacob Cannell MD Executive Director

*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.