The Vitamin D Newsletter March 2009

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All Things Vitamin D

This is a very long newsletter. I will answer questions about oil versus water-soluble Vitamin D, depression, mental clarity, malignant melanoma, Crohn's disease, an imagist poet, multiple sclerosis, sun-exposure, high-intensity red light and collagen repair in the skin, non-alcoholic fatty liver disease, influenza, the 1918 influenza pandemic, statins, the new Food and Nutrition Board, thyroid disease, chronic fatigue syndrome, athletes, the upcoming 14th Vitamin D Workshop, prostate cancer, the wrong blood test, pregnancy, autism, Alzheimer's disease, soap and sebum, asthma, sleep, the co-factors vitamin D needs to work (all contained in spinach), and—my favorite—UVC light and Vitamin D.

Here are the questions. All questions have been edited for clarity, spelling, grammar, brevity, and privacy.

What Type of Vitamin D3?

Water-soluble dry vitamin D absorbs just fine unless you have bowel disease with steatorrea (fat malabsorption) and then no oral products work very well. I am unaware of any controlled head-to-head absorption studies on the effectiveness of water versus fat-soluble vitamin D. If anyone knows of such a study, let me know. If you are concerned about absorption, take the vitamin D with a meal, although I am unaware this improves absorption.

Mental Clarity, Improved Mood, Fewer Colds and Flu

Thank you. Mental clarity, improved mood, and reduction in colds and flu are one of the more immediate consequences (3–4 months) of adequate vitamin D supplementation (5,000 IU/day). Because tremendous genetic variation exists in how one metabolizes vitamin D, a 25(OH)D blood test is crucial. I recommend people save money by not ordering a 25(OH)D blood test until you have been on 5,000 IU/day for 3–4 months.

We are selling in-home vitamin D tests because some doctors refuse to order the 25(OH)D blood test. If they do order it, they often order a 1,25-vitamin D, the wrong test. Everyone should get copies of their vitamin D blood tests and make sure they say 25-hydroxy-vitamin D and not 1, 25-dihydroxy-vitamin D. Even if the doctor orders the right test, 25(OH)D, many do not know how to interpret it, another reason to get a copy of the actual lab report. Acceptable levels of 25(OH)D are 50–90 ng/mL (125–225 nmol/L).

The cost of the correct test through your doctor may be substantial, one or two doctor visits plus the cost of the test. For that reason, the Vitamin D Council offers an accurate, in-home Vitamin D test, the correct test, used in-home, with accurate reporting of results. The cost is usually much lower than going to the doctor, unless you have good insurance. Even if you go to the doctor, the other problems remain. The Vitamin D Council receives a $10.00 donation for each test ordered and that helps us out a lot. Those who want to help can do so, by telling friends and family about the test. For further information about the test please see Am I Vitamin D Deficient?

Crohn's Disease: Better Results With Tanning Bed?

I have several similar reports from patients with both Crohn's disease and ulcerative colitis. Some literature lends support for your results, but not much; several studies have found low 25(OH)D in such patients. Pappa HM, et al. Vitamin D status in children and young adults with inflammatory bowel disease. Pediatrics. 2006 Nov;118(5):1950–61. Gilman J, Shanahan F, Cashman KD. Determinants of vitamin D status in adult Crohn's disease patients, with particular emphasis on supplemental vitamin D use. Eur J Clin Nutr. 2006 Jul;60(7):889–96.

I'm not surprised you had some results with supplements but better results with tanning beds. Some patients with bowel disease have trouble absorbing vitamin D. Here is a case report of improvement in bone pain with sunlamps. It does not mention other symptoms. Koutkia P, et al. Treatment of vitamin D deficiency due to Crohn's disease with tanning bed ultraviolet B radiation. Gastroenterology. 2001 Dec;121(6):1485–8.

As I have said before, briefly sunbathing, with as much skin exposed as possible, at solar noon, when the sun is high enough in the sky, so your shadow is shorter than you are, is the most conservative and sure way to get vitamin D. Who knows what other good thing the sun does? Just don't get burned and realize that summer sun makes vitamin D so fast you only have to stay out 10–30 minutes, depending on how fair you are. Also, as you will see below, washing with soap after being out in the sun, reduces the amount of vitamin D you get. Of course, the sun makes little or no vitamin D during many winter months and most people cannot get naked at solar noon. Vitamin D producing sunlamps are the next best way to get vitamin D as they come close to reproducing the sun's rays indoors. So we looked for the best-in-class in-home UV lights and found them.

On our site's sidebar you will find a link to three different, stand-up, full length, in-home sun lamps. A standard tanning system, the SunSplash Tanning Unit, has both UVA and UVB so you will get a tan. The second system, the D-Lite System, emits Vitamin D-producing UVB with little UVA and full-body high-intensity cosmetic light. Thus you will not tan but can burn if you stay in too long. The third, the SunSplash Renew, is the system that combines tanning with high intensity cosmetic light for the body. All the lamps are the size of a full length mirror and attach to the wall or a door. You stand up in front of them, not lay down, so it is harder to over-expose.

Many women know all about the beneficial effects of high intensity red light on collagen and photo-damage in their skin, but some scientists do not. Lam, et al demonstrated that irradiation of fibroblasts with 633 nm wavelength light increased pro-collagen synthesis four-fold from baseline. Lam TS, Abergel RP, Meeker CA, Castel JC, Dwyer RM, Uitto J. Laser stimulation of collagen synthesis in human skin fibroblast cultures. Lasers Life Sci. 1986;1:61–77.

Human studies confirm such light improves photo-aging and even reduces wrinkles. Russell BA, Kellett N, Reilly LR. A study to determine the efficacy of combination LED light therapy (633 nm and 830 nm) in facial skin rejuvenation. J Cosmet Laser Ther. 2005 Dec;7(3–4):196–200. Goldberg DJ, et al. Combined 633-nm and 830-nm led treatment of photoaging skin. J Drugs Dermatol. 2006 Sep;5(8):748–53.

Here is a PDF of the entire Goldberg article: Combined 633-nm and 830-nm LED treatment of photoaging skin.

The majority of patients in these studies reported this high intensity light improves the softness, smoothness and firmness of their skin. Electron microscopic analysis showed evidence of a post-treatment effect, with thicker collagen fibers. I use the D-Lite with full-body UVB and high-intensity longer wavelength light. It works for me; at least it seems to reduce prior photo-damage, like the studies indicate. If you don't want to tan, the D-Lite does not tan, but lots of vitamin D producing UVB, thus it will burn. Be warned, these lights are expensive, so you may just want to go to a sun tanning parlor in the winter and enjoy the summer sun during the warmer months. If you use a sun tan parlor, be sure to ask for the low pressure beds; do not use high-pressure UVA lights. Another good thing, for every in-door UV light sold, the Vitamin D Council receives a donation of 20% of the purchase price. So you will be making a donation to a good cause.

Sunbeds, Sunscreens, and Malignant Melanoma

Most studies indicate they do, as do sunburns and intermittent sun exposure. However, not all studies show such a relationship, in fact, one of the largest studies showed sunbed use had a small protective effect against melanoma. Individual factors, such as numbers of moles and skin type were the strongest risk indicators for melanoma, not UV exposure. Bataille V. A. et al. Multicentre epidemiological study on sunbed use and cutaneous melanoma in Europe. Eur J Cancer. 2005 Sep;41(14):2141–9.

Others believe the risk is unclear. de Winter S, Pavel S. Tanning beds: effect on skin cancer risk unclear. Ned Tijdschr Geneeskd. 2000 Mar 4;144(10):467–70.

In fact, the risk of melanoma from UV light appears small compared to risk factors such as skin type and nevus counts. Bataille V. et al. Exposure to the sun and sunbeds and the risk of cutaneous melanoma in the UK: a case-control study. Eur J Cancer. 2004 Feb;40(3):429–35.

Ironically, sunscreens may increase the risk of melanoma. Westerdahl J. et al. Sunscreen use and malignant melanoma. Int J Cancer. 2000 Jul 1;87(1):145–50. Gorham ED et al. Do sunscreens increase risk of melanoma in populations residing at higher latitudes? Ann Epidemiol. 2007 Dec;17(12):956–63.

In one of the best studies, the factor most associated with increased melanoma risk was the use of sunscreens. Subjects who often used sunscreens had triple the melanoma risk compared with subjects who never used sunscreens. Skin color and higher numbers of sunbaths were significant protective factors. Subjects who took more than 30 sunbaths per year were ten (10) times less (less) likely to have melanoma, compared with subjects who took less than 20 sunbaths per year. However, sunbaths had no protective value when they were associated with sunburns. Wolf P, et al. Phenotypic markers, sunlight-related factors and sunscreen use in patients with cutaneous melanoma: an Austrian case-control study. Melanoma Res. 1998 Aug;8(4):370–8.

Other studies show the risk is increased only with intermittent UV exposure, and not with chronic exposure. Walter SD, King WD, Marrett LD. Association of cutaneous malignant melanoma with intermittent exposure to ultraviolet radiation: results of a case-control study in Ontario, Canada. Int J Epidemiol. 1999 Jun;28(3):418–27.

This month, Dr. Dianne Godar, of the United States Food and Drug Administration, published a fascinating paper indicating UVA light, even through window glass, is responsible for the melanoma epidemic. She points out the melanoma epidemic began long before sunbeds; the dramatic increase is only in indoor workers, not outdoor workers; low 25(OH)D levels predict melanoma; all-year tans protect against melanoma; and melanoma patients who expose themselves to the sun live longer than those who don't. Of the 14 published studies, she reported only two found a positive association between solar UV exposure and melanoma; seven found no association; and five studies found an inverse association, that is, the more sun-exposure the less melanoma. Godar DE, Landry RJ, Lucas AD. Increased UVA exposures and decreased cutaneous Vitamin D(3) levels may be responsible for the increasing incidence of melanoma. Med Hypotheses. 2009 Apr;72(4):434–43.

Ironically, sunscreens appear to dramatically increase the risk of melanoma, probably by increasing the amount of time one spends in the sun. Until recently, sunscreens only blocked vitamin D-producing UVB and let UVA through. That is, the sunscreen-promoting dermatologists many be partially responsible for melanoma epidemic.

I use an in-home UVB light, the D-Lite mentioned above, that emits little UVA. However, I limit myself to short exposures and I do sunbathe in the summer, but briefly. I also keep my 25(OH)D level at 70 ng/mL. My advice is to read about the issue before you buy an in-door UV light. UV lights and natural sunlight will age the skin and increase the risk for squamous cell carcinoma of the skin. If you worry about it—at all—stick to vitamin D supplements and stay away from indoor UV lights. Remember, some people who use indoor UV lights will get melanoma; some people who never use them will get melanoma; and many people who avoid sunlight will get melanoma. If you do use indoor UV lights, use them sensibly, avoid sunburn, and respect them as you respect the sun.

The Poetry of Skipwith Cannell

He was my father. If you like old things, here is a link to one of my father's earliest publications, in a 1915 edition of Poetry, a Magazine of Verse. Three of his poems appeared just before the initial publication of T.S. Elliot's, the Lovesong of J. Alfred Prufock, my favorite poem. My father's poetry was dark:

The Temple of Hunger

There's a temple, dark and silent,
Littered with dust and bone,
Where the countless hoards of the starving,
Bow at the lean God's throne.

In the chilling gloom by the alter,
Whence even hatred has fled,
Sits the God of Hunger gloating,
Over tribute of starven dead.

Before him, and beaten and bitter,
From eastern and western lands,
Cringe the people the God of Hunger,
Will crumple between his hands.

Silent they crouch and hopeless;
Each with a look that sees,
Each one but a stricken shadow,
Its forehead upon its knees.

If you have been to some African countries, you know the God of Hunger is alive and well.

Vitamin D and Multiple Sclerosis

Yes a number of epidemiological studies suggest vitamin D has a treatment effect in MS, such as fewer exacerbations in the summer, not just a preventative effect. However, we now have more direct evidence that vitamin D helps treat MS. In an open study of 12 patients by Kimball, et al, the number of lesions per patient (assessed with a nuclear magnetic brain scan) decreased in the treatment group from the initial mean of 1.75 to the end-of-study mean of 0.83. Kimball SM, Ursell MR, O'Connor P, Vieth R. Safety of vitamin D3 in adults with multiple sclerosis. Am J Clin Nutr. 2007 Sep;86(3):645–51.

The question is what do you do if you have MS, while we are waiting for more studies? If you have MS, do you wait and see if your MS is going to progress? Does your doctor? In my opinion, it is unethical for doctors to ignore vitamin D deficiency in serious diseases, such as MS, and most doctors do. MS patients should take the initiative themselves, getting their 25(OH)D into the high range of normal (70–90 ng/mL) while we are waiting for more science. This may require up to 10,000 IU/day in some people, an indoor UV light, or a sun tan parlor.

Low 'D' — Even With Sun Exposure

You may have a genetically determined predilection to low levels, that is, your body may break 25(OH)D down quickly or make it slowly. Do you shower with soap after you sunbathe? If so, you may be washing off the vitamin D-containing body oils (sebum); please see a question below. Also, remember what I said about solar noon? In Michigan, even in the summer, the sun is not high enough up in the sky to make much vitamin D, except for one or two hours on each side of solar noon. While it is true that your shadow must be shorter than you are to make vitamin D, the shorter the shadow the more the D, and the relationship is not linear. That is, you really want the sun high up in the sky. Air pollution also reduces UVB. For you, simply shirtless will not do it; you need full body exposure. Also, the Michigan vitamin D winter—no UVB for four months—is another reason we now market the in-home UV lights. A commercial sun tan parlor is another option. Dr. Binkley and colleagues found the same thing in Hawaii that you found in Michigan. I suspect the surfers and skaters were washing off their vitamin D. Binkley N, et al. Low vitamin D status despite abundant sun exposure. J Clin Endocrinol Metab. 2007 Jun;92(6):2130–5.

Vitamin D and Liver Disease

This topic is close to my heart as my wife was so diagnosed, had a liver biopsy, and told to expect progressive liver disease. The hepatologist even talked about a liver transplant well in the future, which scared us both to death. Her liver function tests first went down, then came close to normal, and are now low-normal on 5,000 IU per day! A single human study strongly supports this: Targher G, et al found decreased 25(OH)D concentrations were closely associated with the histological severity of hepatic steatosis, necroinflammation, and fibrosis, (Png/mL. If you do not have liver disease, do the same. Targher G, et al. Associations between serum 25-hydroxyvitamin D3 concentrations and liver histology in patients with non-alcoholic fatty liver disease. Nutr Metab Cardiovasc Dis. 2007 Sep;17(7):517–24.

Vitamin D and Influenza

While others have claimed it, I have never claimed vitamin D will prevent all cases of influenza, if that is what you had. Furthermore, some are claiming vitamin D is all that is needed to prevent the next influenza pandemic. I believe that to be a dangerous belief. Vitamin D will help the innate immune system, but other crucial factors in influenza pathology are the novelty, transmissibility, and virulence of the attacking virus. As we attempted to say in our paper before it was cut by the editor:

"It would be a mistake to overestimate the role of innate immunity. One does not have to go back to 1918 to discover evidence that highly transmissible novel virus can overwhelm innate immunity. Shortly after authorities documented Asian influenza in the USA, 80% of 300 girls attending a 20 June 1957 conference in Davis, California fell ill. It would be irresponsible to hypothesize that 80% of the girls, presumably most from California, were vitamin D deficient, at latitude 38 degrees, the day before the summer solstice—during an era when sun-exposure was common. Although the girls' illness was relatively mild, the fact that they sickened at all is testament to the vital role of novelty, transmissibility, and virulence." Cannell JJ, Zasloff M, Garland CF, Scragg R, Giovannucci E. On the epidemiology of influenza. Virol J. 2008 Feb 25;5:29.

In fact, in the 1918 pandemic when 350,000 Americans died, blacks were less likely to be sickened than whites, and the group most likely to have the highest vitamin D levels, young adults, was the group most afflicted. Many of the young adults died of a "cytokine storm," where the body's innate immune system attacks the body, in their case the lung. Jordan EO. Epidemic influenza, a survey. Chicago: American Medical Association,1927.

Perhaps having a modest amount of vitamin D in your blood meant the innate immune system was able to mount such an assault, while having very little vitamin D may have protected you from such a death, while high vitamin D protected you. I suspect, but cannot prove, that having levels around 50–80 ng/mL will help protect you against the next pandemic; the innate immune system will temper its self-attack and, in some cases, kill the virus at the same time. I repeat, vitamin D will not protect the world from the next influenza pandemic. However, if I live to face it, it will be with a 25(OH)D level of 70 ng/mL.

Statins and Vitamin D

Statins deplete coenzyme Q10 levels, which may cause a potentially serious myositis (muscle inflammation) in some patients. Vitamin D reversed this in 92% of the patients. If you take statins, get your 25(OH)D level above 50 ng/mL. If you don't take statins, do the same. Ahmed W, et al. Low serum 25 (OH) vitamin D levels (ng/mL) are associated with reversible myositis-myalgia in statin-treated patients. Transl Res. 2009 Jan;153(1):11–6.

New Food and Nutrition Board

That is exactly the problem with many doctors here in the United States. However, you can get your blood tested. Our in-home Vitamin D blood test is available to those who live overseas, just add $20.00 extra for shipping. As for the current RDA (actually, Adequate Intake or AI), a new Food and Nutrition Board (FNB) has been convened and let's hope they do it right. The key problem with the 1997 FNB was they forgot to correct for the sun-scare. As the sun-scare spread, vitamin D levels fell. It was the responsibility of the 1997 FNB to recommend increased vitamin D to make up to sun avoidance. But they didn't.

Here are the members of the new FNB. Email them all and tell them what vitamin D did for you, and tell them the dose you needed for a full effect.

Dr. A. Catharine Ross (Chair), Pennsylvania State University

[email protected]

Dr. Steven A. Abrams, Baylor College of Medicine

[email protected]

Dr. John F. Aloia, Winthrop-University Hospital

[email protected]

Dr. Patsy M. Brannon, Cornell University

[email protected]

Dr. Steven K. Clinton, The Ohio State University

[email protected]

Dr. Ramon A. Durazo-Arvizu, Loyola University Chicago Stritch School of Medicine

[email protected]

Dr. J. Christopher Gallagher, Creighton University Medical Center

[email protected]

Dr. Richard L. Gallo, University of California San Diego

[email protected]

Dr. Glenville Jones, Queen's University

[email protected]

Dr. Christopher S. Kovacs, Memorial University of Newfoundland

[email protected]

Dr. JoAnn E. Manson, Harvard Medical School

[email protected]

Dr. Susan Taylor Mayne, Yale University School of Medicine

[email protected]

Dr. Clifford J. Rosen, Maine Medical Center Research Institute

[email protected]

Vitamin D and Thyroid Disease

Thanks you for your comments. A recent study showed a weak correlation between 25(OH)D levels and thyroid antibodies, but get this, in India, the average 25(OH)D level was only 17.5 nmol/L or 7.5 ng/mL! Of course the association they found was weak, no one had high enough levels to find the true association. It appears no one in India takes vitamin D or bares their skin. Again, our 25(OH)D in-home tests are available overseas. If you have thyroid disease, get your 25(OH)D levels up above 50 ng/mL (125 nmol/L). If you don't have thyroid disease, do the same. Goswami R, et al. Prevalence of vitamin D deficiency and its relationship with thyroid autoimmunity in Asian Indians: a community-based survey. Br J Nutr. 2009 Feb 10:1–5.

Fibromyalgia and Vitamin D

You're welcome. You have a good endocrinologist. However, many patients with fibromyalgia report they cannot take vitamin D. For those people, I recommend sun tanning parlors or one of our in-home UV units. If you keep your level above 50 ng/mL, you should be able to live a normal life now.

As far as dying, remember, everyone who takes Vitamin D will die. It's simply a question of when. What we hope, even expect, is vitamin D will square off the mortality curve. Now, people start dying from the diseases of civilization in their forties, struck down by heart disease, cancer, etc. Premature deaths accelerates in the 50s and are in full swing by the 60s. That is, the mortality curve slops downward, beginning in the late 40s, people succumbing to the diseases of civilization. Perhaps vitamin D will allow people to live normal lives until they reach their 90s–100s, when we will all suddenly drop dead of old age!

When the famous Dr. Denis Burkitt noted that "diseases of civilization" were rare in Africa—although many patients died of malaria or gastrointestinal diseases—he was working in Uganda, right on the equator. What Dr. Burkitt failed to notice, when he hypothesized it was fiber in the diet that prevented the diseases of civilization, was his patients frequently wore little clothing and were under an equatorial sun 365 days a year. Dr. Burkitt thought it was fiber, but it was the vitamin D.

Improved Muscular Performance With Vitamin D

Yes. If you remember, I first theorized that Vitamin D would improve athlete's abilities in our March 2007 Vitamin D Newsletter.

I found evidence vitamin D allowed the Germans and Russians to dominate the Olympics for 30 years, from the mid 1950s until the mid 1980s, when the sun-scare allegedly convinced them to stop irradiating their elite athletes. I'll be speaking at the American College of Sports Medicine on the subject at their late May conference in Seattle. I'll be around Wednesday and Thursday; I speak on Wednesday at 4:25 pm. Before and after that I'll be at the Vitamin D Council's booth, if the Council has enough money to pay the $1,525 for a booth. If you are in Seattle, stop by.

As far as supporting research, Ward, et al recently found Vitamin D is highly associated with how high young teenage girls could jump. Unfortunately, Dr. Ward, the lead author, and the editors at the Journal of Clinical Endocrinology & Metabolism, did not credit my prior publication. Ward KA, et al. Vitamin D status and muscle function in post-menarchal adolescent girls. J Clin Endocrinol Metab. 2009 Feb;94(2):559–63.

14th Annual Vitamin D Workshop

For those who don't know, this is the best Vitamin D conference in the world. Tony, I will be there if the Vitamin D Council has any money to finance my trip.

Vitamin D Treats Prostate Cancer!

Yes. Do you remember the press articles last autumn about breast cancer, which showed afflicted women with the highest 25(OH)D levels were much less likely to die from breast cancer than women with the lowest levels? You should, it literally generated 1,500 press stories in English language publications. Well, the same exact study, with even better results, was published last month by Dr. Treti and colleagues in the British Journal of Cancer. This time, it was men with prostate cancer not women with breast cancer.

The study showed that men with biopsy proven prostate cancer, who had the highest vitamin D levels, were up to 6 times less likely to die than men with the lowest levels over the 4 years of the study. Six times! That is a treatment effect, so yes you should take vitamin D. How much, I don't know. If it was me, I'd take enough to get my levels up to 80–90 ng/mL and I'd do it quick. Be prepared for your body to become a battlefield as the vitamin D attacks and attempts to kill the cancer cells. Also, check your serum calcium frequently, as the macrophages in the battlefield may start producing high amounts of activated vitamin D and drive up your serum calcium. Tretli S, Hernes E, Berg JP, Hestvik UE, Robsahm TE. Association between serum 25(OH)D and death from prostate cancer. Br J Cancer. 2009 Feb 10;100(3):450–4.

Do you know how many press articles Dr. Treti's prostate cancer study generated? Not one. I followed it closely on Google News Alert for "Vitamin D." (To view the latest news on vitamin D please visit our Vitamin D News page.) I guess the war between the sexes goes to the grave. Actually, as I have said before: "When I was young, I suspected conspiracy; as I grow older, I know it's incompetence." The press simply did not see the publication, but it is not too late for them to correct their sexist mistake.

Vitamin D Testing

Your doctor ordered the wrong test. He ordered a 1,25-dihydroxy-vitamin D, which is usually elevated in vitamin D deficiency. As your deficiency worsened, your 1,25-dihydroxy-vitamin D went up further. You need a 25-hydroxy-vitamin D blood test, which will be very low. You could have saved yourself all this misery by ordering the Vitamin D Council's in-home test.

By the way, I believe that Quest Diagnostics is now offering reliable 25(OH)D blood tests. Unfortunately, I believe they are reliably 25% higher than the gold standard, DiaSorin RIA, the test used in virtually all the recent studies, so if you use Quest, divide their results by 1.3. Shoot for > 50 ng/mL.

Autism and Vitamin D

1,000–2,000 IU/day for autistic children is inadequate. Aggressive vitamin D deficiency diseases need aggressive vitamin D treatment. Start with a minimum of 5,000 IU/day day in autistic children and check 25(OH)D levels every month. Many autistic children will need even more to see a full treatment effect. Please remember the difference between a treatment effect and a cure.

1,000 IU/day during pregnancy is also entirely inadequate. You need 5,000 IU/day, often more, and a 25(OH)D blood test to assure 5,000 IU/day gets you up above 50 ng/mL. If you are uncomfortable with that dose, buy one of our in-home vitamin D lights. Conventional wisdom is that you should not use sun-tanning parlors during pregnancy as they increase body temperature, which may harm the fetus. Our in-home UV lights are open, hang on the wall like a full-length mirror, and thus will not raise body temperature. As for the reasons pregnant women need 5,000 IU/day, I will soon dedicate an entire newsletter to vitamin D and pregnancy.

The problem is that pregnant women are told not to take any pills or supplements, except prenatal vitamins, which contain truly inconsequential amounts of vitamin D. Most pregnant women will not take vitamin D unless their obstetrician tells them to do so, and not doing so may have devastating effects on their unborn child. If you are pregnant, you need at least 5,000 IU per day. If you live where the sun makes vitamin D this time of year, sunbathe for 10–30 minutes every day. If you can't do that, and if you will not take it as a supplement, another option is an in-home UV Vitamin D unit.

Yes, two recent studies supported my theory. The first showed autistic children have abnormal bones, what one would suspect in children who have a genetic abnormality in metabolizing or catabolizing vitamin D. Hediger ML, et al. Reduced bone cortical thickness in boys with autism or autism spectrum disorder. J Autism Dev Disord. 2008 May;38(5):848–56.

The second showed cloudy and rainy weather (which is a proxy for reduced UVB) is associated with autism. Waldman M, Nicholson S, Adilov N, Williams J. Autism prevalence and precipitation rates in California, Oregon, and Washington counties. Arch Pediatr Adolesc Med. 2008 Nov;162(11):1026–34.

Vitamin D, Dementia, and Cognitive Function

Yes, increase the dose to 7,000 IU per day and test 25(OH)D levels until her level gets to 70–90 ng/mL. More aggressive treatment is indicated in aggressive diseases. While several studies have shown an association between dementia and vitamin D, two recent studies showed cognition in dementia patients is better in those with higher 25(OH)D levels. As a physician, I'm sure you know the difference between a treatment effect and a cure. Oudshoorn C, et al. Higher serum vitamin D3 levels are associated with better cognitive test performance in patients with Alzheimer's disease. Dement Geriatr Cogn Disord. 2008;25(6):539–43. Llewellyn DJ, Langa K, Lang I. Serum 25-Hydroxyvitamin D Concentration and Cognitive Impairment. J Geriatr Psychiatry Neurol. 2009 Feb 4.

Ultraviolet Light Produces Vitamin D

UVB, right? Actually, it may be UVC, not UVB. Of course that is irrelevant on earth as UVC does not penetrate the earth's atmosphere. But if you ever want to sunbathe on the moon, read on. In fact, the belief that UVC radiation does not produce vitamin D is firmly rooted in the scientific community, but is a widespread misconception. While UVC radiation does not produce vitamin D in the skin upon exposure to sunlight, it is not because UVC radiation fails to trigger production of vitamin D; it is because UVC radiation is not present in the sunlight reaching earth—two very different facts.

I am unaware of any human studies using only UVC light to see if it increases 25(OH)D levels. However, animal studies clearly indicate wavelengths in the UVC range are very effective in producing vitamin D; in fact, UVC appears to be equal to—or more efficient—than UVB for production of vitamin D. For example, Bunker, et al found UVC radiation effective in both photochemically activating 7-dehydrocholesterol into vitamin D and in treating rachitic rats. Three of the following four references allow full version downloads of the papers, so you can read them yourself. Bunker JWM, et al. Relative efficiency of active wave-lengths of ultraviolet in activation of 7-dehydrocholesterol. J. Am. Chem. Soc. 1940, 62(3):508–511.

Knudsen and Benford studied numerous UV wavelengths in rachitic rats, finding UVC was more effective in curing rickets than any of the UVB wavelengths studied. They also found that larger doses of UVC, "even up to 8 times the dose required to produce healing, did not produce any more healing; in fact, somewhat less." Excessive doses of UVC, like UVB, degrade more vitamin D than they produce. Knudsen A and Benford F. Quantitative studies of the effectiveness of ultraviolet radiation of various wavelengths in rickets. J. Biol. Chem. 1928,124;287–299.

Some correctly say that UVC does not penetrate the outer layer of the skin very well, implying that fact would prevent vitamin D production even if UVC were effective in producing vitamin D. They fail to point out that such UV penetration of the skin is not necessary for vitamin D production. Hume, et al demonstrated that rabbits and rats respond equally well to topical vitamin D as they do to UV irradiation, both methods rapidly curing rachitic animals. That is, vitamin D is absorbed readily through the skin. Gaylor, et al found sebum contains large amounts of vitamin D's precursor, 7-dehydrocholesterol; up to 75% of 7-dehydrocholesterol in rat skin occurs in sebum. Hume EM, et al. LII. On the absorption of vitamin D from the skin. Biochem J. 1927, 21:362–367. Gaylor JL, Sault FM. Localization and biosynthesis of 7-dehydrocholesterol in rat skin. J Lipid Res. 1964,5(3):422–31. (PDF format)

These last two studies raise the possibility that sunbathing or using UV lights may not produce much vitamin D if you shower with soap after exposure. Water cleans the body but does not destroy as much sebum, human body oil. When you think about it, God made the perfect body oil for humans—sebum—but humans wash off her body oil and then apply body oils made by the cosmetic industry. I doubt she likes that.

Vitamin D and Ovarian Cancer

I am not sure the Vitamin D had anything to do with it. She could have been cured by conventional treatment; such cures occur every day. The Vitamin D may or may not have helped. However, why take a chance?

Vitamin D Helps Asthma

I have heard of numerous similar asthma cases. She should slowly stop her medication, if her doctor agrees. A paper was recently presented showing exacerbations in asthmatic children were associated with low 25(OH)D levels. In the adjusted models, children with insufficient vitamin D were about 70% more likely than those with sufficient vitamin D to have exacerbations. The levels of only a few of the children, asthmatic or not, were adequate. Zoler, M. Low vitamin D linked to asthma exacerbations. Pediatric News. 2008, July 1.

By the way, instead of taking 62 capsules per day of the 2,000 IU, she could have taken 2 or 3 or the 50,000 IU capsules that are available.

Vitamin D and Depression

Glad to be of help, don't worry about a contribution, we will find it somewhere. Be sure to eat a lot of spinach with your vitamin D. To work properly, vitamin D needs magnesium, vitamin K, zinc, and probably boron. We hope to soon have a complete vitamin D on the market with all these co-factors but you can save some money by just eating spinach every day.

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:

• The Vitamin D Council
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• San Luis Obispo, California, United States, 93401

John Jacob Cannell MD Executive Director