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Vitamin D: Great potential for congestive heart failure?

Posted on: September 18, 2013   by  John Cannell, MD

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Cardiomyopathy (literally “heart muscle disease”) is the failure of the heart muscle to pump enough blood. It leads to congestive heart failure (CHF), the severity of which is measured using ultrasound, such as ejection fraction, or the percentage of blood that is pumped with each beat. Often a blood test for a marker called proBNP is elevated. Common symptoms of cardiomyopathy are breathlessness, having to sit up while sleeping, and swelling of the legs. It is a lethal disease.

By far the most common cause of cardiomyopathy is extrinsic ischemic arthrosclerosis. However, there is a type of cardiomyopathy called idiopathic cardiomyopathy, which simply means the cause is unknown. For unknown reasons, the heart muscle cells are unable to contract strongly enough to pump enough blood. Idiopathic cardiomyopathy is generally a disease of younger people.

I have written about this before.

Can vitamin D improve the severity of congestive heart failure? April 8, 2013 by John Cannell, MD  

In infants and children, it is well known that vitamin D deficiency is a cause of cardiomyopathy. Doctors usually find low blood calcium together with CHF and then measure vitamin D levels to make the diagnosis of vitamin D deficient cardiomyopathy.  An Egyptian researcher did a randomized controlled trial of 80 infants showing vitamin D had a dramatic treatment effect in 10-month olds with congestive heart failure of all kinds.

Infant heart failure and vitamin D supplementation.  February 28, 2012 by John Cannell, MD

What has never been done, as far as I can tell, is to study the treatment effect of vitamin D in adult idiopathic cardiomyopathy. I can’t even find a case series or a case report. That is, apparently no physician has ever thought of treating adult idiopathic cardiomyopathy with vitamin D, although vitamin D has been used to help treat idiopathic infantile cardiomyopathy.

Recently Doctor Ahmad Amin, working under Professor Maryam Ardeshiri, treated 100 consecutive CHF adult patients (55 of which had cardiomyopathy) with 50,000 IU/week of vitamin D3 for 8 weeks followed by 50,000 IU/month for 2 more months. Mean 25(OH)D increased by 17 ng/ml. The average age was only 42 so a high percentage of these patients probably had idiopathic cardiomyopathy.

Amin A, Minaee S, Chitsazan M, Naderi N, Taghavi S, Ardeshiri M. Can vitamin d supplementation improve the severity of congestive heart failure? Congest Heart Fail. 2013 Jul;19(4):E22-8.

They found a dramatic treatment effect of vitamin D. During 12 weeks of treatment with vitamin D, mean functional class of CHF improved significantly (P<.001). Furthermore, a significant reduction in proBNP (P<.001) occurred. Vitamin D supplementation also significantly improved the distance the patients could walk in six minutes (P<.001). CRP fell significantly (P<.001). Ejection fraction and other ultrasound measurements improved significantly (P<.001).

This was a remarkable study.

In a study from last year, Doctor Israel Gotsman and colleagues from the Heart Institute at Hadassah University Hospital in Jerusalem studied congestive heart failure (from all causes) and vitamin D in a very large group of patients. Doctor Gotsman worked under senior author Professor Dan Admon.

Gotsman I, Shauer A, Zwas DR, Hellman Y, Keren A, Lotan C, Admon D. Vitamin D deficiency is a predictor of reduced survival in patients with heart failure; vitamin D supplementation improves outcome. Eur J Heart Fail. 2012 Apr;14(4):357-66.

In their study, they included patients with CHF, although they didn’t specify the cause of the CHF. However, since the average age was about 75, many of the patients likely had ischemic cardiomyopathy and not idiopathic cardiomyopathy, which is a disease of younger persons. They also included a control group.

Here is what they found:

  1. The 3,000 patients with CHF had lower 25(OH)D levels than the control group. No surprise here, as patients with CHF are less likely to go outside. In the CHF group, 28 percent of this population had significant vitamin D deficiency (<10 ng/ml) and only 8.8% had levels > 30 ng/ml.
  2. The lower the baseline 25(OH)D level, the more likely patients were to die over the next year and a half (P <0.00001). This has been shown before a number of times.
  3. Sixty-three percent of the 3,000 CHF patients were prescribed vitamin D (1,000 IU/day).  Such supplementation was associated with a significantly reduced death rate (P<.0001). This was a big surprise.

The authors concluded,

“Vitamin D deficiency is highly prevalent in CHF patients as well as in the general population, even in a geographic location with exposure to abundant solar radiation. Vitamin D deficiency was a significant predictor of reduced survival in both CHF patients and the control groups. In addition, vitamin D supplementation was associated with increased survival in CHF patients.”

What do these and other studies tell us?

They tell us that patients with CHF, whether ischemic or idiopathic, should make sure they’re sufficient in vitamin D. And they raise the possibility that some CHF patients may see some treatment effect with 5,000 IU/day of vitamin D3 or even as high as 10,000 IU/day. It may be that some adults with idiopathic cardiomyopathy have it for the same reason some children do, vitamin D deficiency.

11 Responses to Vitamin D: Great potential for congestive heart failure?

  1. Rita and Misty

    Salutations and greetings, Dr. Cannell:

    I would think that many of the diseases we typically associate with aging, like Ischemic CHF, are in reality diseases of vitamin D deficiency. These would include our modern chronic conditions like diabetes II, high blood pressure, insomnia, depression, and rheumatoid arthritis (just to name a few).

    No one should be deficient in vitamin D. It is such an easy thing to diagnose and treat.

    Physicians reading this blog, please test your patients with the 25(OH)D test, and look for optimal levels between 50 ng/ml–80 ng/ml. Supplement deficient patients with 10,000 iu D3 daily for 8 weeks to quickly treat the deficiency. Then, tell your patients to continue supplementing with 5,000 iu D3 daily….for the rest of their lives. And, yes, do test their blood at least once-a-year.

    And, physicians, please educate your colleagues to do the same. It is the ethical thing to do.

    Even the ignorant NIH openly states 10,000 iu D3 daily is safe.

    Let ‘s roll ourselves up and end this pandemic.

    Be well,
    Rita

  2. Brandowbarry

    My 14 year old Eng. Springer Sp. was acting as if his back was stiff and had a little trouble with his rear legs. Vet started “VOM” ( vet. ostiopathic manipulation, read chiropractic) which at first seemed to help BUT I had already started 1200 iu/day of D3. After a bout of Horner’s syndrome related to the VOM, we stopped the VOM with no obvious difference but my dog was acting much better in spite of a newly discovered heart murmur. Took him to a cardiologist who dignosed advanced congestive heart failure (with a 6 month prognosis). Four months in, dog is acting like a puppy and is full of life. I wanted him to have a good “last summer” and he has. My sense has been that the D3 (as well as the meds prescribed for the cardiomyopathy) has been instrumental in the improvement of his quality of life which was evident before the drugs were started. This article reinforced my feelings. BTW, the vet. warned me not to supplement with D3 as it could be toxic and referred me to articles (on the net) addressing overdoses due to ingestion of D3 based rodent poison. I would encourage more attention on D supplementation for our “best friends”, as I have found it hard to find any “trustworthy” data on this issue.

  3. IAW

    So no one thinks “Brandowbarry” is crazy, I also give my dog D3. She is a 40 lb Terrier/Shepard mix from the pound. I give her 2000 iu D3 a day. Although this has not solved all her medical issues, I do believe it helps. I have been doing this for about 2 years. Do not get me started but I think she is in “poor health” from one too many vaccines. I wish I had known better at the time.

  4. Rita and Misty

    Salutations and greetings!

    Misty, that adorable redhead sitting next to me, is an elderly Australian Shepherd. She has been taking 4,000 iu D3 weekly, in divided doses, for two years now.

    She has the energy level of a doggie much younger than her approximate 13-15 years.

    Misty weighs 60 lbs…give or take…

    Prior to commencing with D3 supplementation, Misty did have those fatty tumors elderly canines are so prone to developing. Those tumors have disappeared. I have no proof that it is the D3, but I can say that her vet is always amazed at how healthy Misty is at this stage in her life.

    Australian Shepherds are subject to arthritis as they get older. Misty has very few muscular problems, and her skeletal structure is very sturdy. She loves to jump, run and play.

    I encourage any veterinarians reading these comments to do some research and talk with colleagues.

    Yes, indeed, our four-footed best friends will benefit from D3 supplementation too!

    Be well,
    Rita (and Misty)

    🙂

  5. showmeaschematic

    Brandowbarry :

    I must add my canine experience….. I have a black Lab, female. Three years ago, at age 9, she becaome lethargic, refused food often… and walked without spirit, almost dragging herself.
    I suspected perhaps Lyme disease… went to vet.. who took x-rays and blamed arthritis in spine. We began arthritis meds… solely as diagnostic tool They were expensive and didn’t help at all. I discontinued them.
    Time dragged on for many months. Then, one day, while getting my vitamin D at breakfast, I thought that my dogs ( I have 2 ) were indoors most of the time, and I live at 45 degrees latitude, so maybe they were deficient too. I wasn’t specifically thinking of the previous problem. I coated 2 pills in peanut butter and added it to their food. So, that was 1,000 IU’s per day I gave them.
    To my surprise, within 2 weeks, the lethargic Lab was eating normally again and, on her walks, her step had that bouncy, full of energy look.
    She is 12 years old now and still is unchanged and doing well. To boot…. last year she developed a swollen abscess in her molar root… and I dreaded taking her to the vet because I knew it would be surgery, both expensive and painful for her, and I wanted to try and keep her tooth. I had read the book ” Vitamin K2 and the Calcium Paradox ” so was regularly taking K2 and Vitamin A ( Halibut oil ) along with my D. I knew from the book that this combination was capable of curing dental problems and making teeth immune to decay. I can feel the difference in my 63 year old teeth. So I slipped a 100 microgram tablet of K2 and a 5,000 IU vitamin A in her food Daily along with the D. Within a week the abscess had disappeared and it has been gone ever since.
    Proof enough for me.

  6. Rita and Misty

    Apoptosis induction of POS canine osteosarcoma cells by vitamin D and retinoids.

    There is a link to full text article:
    http://www.ncbi.nlm.nih.gov/pubmed/9853313

  7. anniecmars@yahoo.com.au

    My Dad is 94 and has CCF(CHF). He had a vit D test recently. He has annual tests and was around 130 nmol/l (52 ng/ml), 138 nmol/l (55 ng/ml) over the previous two tests. We have just come through winter and, although it is spring, we have had very little sunny weather so he has kept up his supplements. His last test came in at 148 nmol/l (59/mg/ml) which is still well within the ideal range, but his Dr immediately told him to stop supplementing! Fortunately Dad has done his reading on vitamin D and so is just going to continue with supplements as he has been – take his supplements on days he doesn’t get enough time out in the sun between 10 am and 2 pm. Why is there such amazing paranoia about having a level above 100 nmol/l??? I just don’t get it. His CCF makes him prone to chest infections and even with his excellent vit D level, he still needed a course of antibiotics in August. I truly believe, and so does he, that he wouldn’t be with us if he didn’t supplement with vit D. He also takes magnesium, a good multi vit, a mega B and coenzyme Q10 (which assists the heart as well). He is on very few prescription medications – a fairly low dose of blood pressure med and just recently he has started on a daily fluid tablet to reduce the fluid on his lungs as he was getting breathless on exertion, but he can still drive and although he does the lawns in little bites now, is still mowing his own lawn with a motor mower – a push along, not self propelled. He has a vegie garden he tends and he has less weeds in his flower garden than I do! He can’t wait for the better weather so he can get out and sit in the sun and get the full benefits of those wonderful rays!!! – PS: he had a very small skin cancer removed off the back of his hand recently – healed well and is only the second one he has ever had to have removed – the other was very small too – just goes to show, keep an eye on your skin, and get some sun!

  8. IAW

    To: anniecmars@yahoo.com.au
    I feel it is going to take a really long time to get enough information out there to stop this “paranoia” about Vitamin D. Until then the acceptable range (at least in the U.S) goes from 32 – 100 ng/ml. This is what I would keep telling the doctor.
    I maintain a D level well over 100. So does the rest of my family. Has your Dad considered taking a little more? You did not say how much he takes a day.

  9. Rita and Misty

    Greetings Annie and IAW:

    I have some thoughts (as I always do!):

    1. The “paranoia” regarding the sun was actually a very successful marketing campaign instigated by the sunscreen industry, and hand-in-hand with dermatologists….

    2. The vitamin D community might be wise to consider a campaign of its own, hand-in-hand with nutritional companies and endocrinologists….

    3. IAW–the acceptable range (in the USA) for 25(OH)D level is now down to 20 ng/ml. The IOM actually ONLY ruled 20 ng/ml on bone health; but GPs are (unfortunately) utilizing 20 ng/ml as acceptable across the board. Perhaps because IOM stated it did not know the beneficial 25(OH)D level for other health conditions.

    🙂

    LIfe is a journey…with obstacles along the way… this statement applies to the life of the vitamin D community as well… Obstacles are meant to go over, around, thru or under…. imo.

    🙂

  10. IAW

    To: Rita
    My daughter was the last to be tested in my family. This was June 2013. LabCorp range says 30.0 – 100.00 ng/ml. They then have a paragraph that states… IOM deficiency defined as less than 20 ng/ml and then they say The Endocrine Society further defines insufficiency as between 21 -29 ng/ml. Her level was 143.2 ng/ml.

  11. Rita and Misty

    Greetings IAW 🙂

    I utilize ZRT Lab and it also has a range of 30 ng/ml — 100 ng/ml…. My range in July was 166 ng/ml, I stopped supplementation for 3 weeks to bring down the level. Coincidentally, around week 3, my hormones raised their wicked heads. Hot flashes and a missed cycle resulted!!! Once I resumed supplementation, all went back to normal…or at least monthly regular 😉 At nearly 49 years of age, I am happy for this!!!!

    At the (nameless)institution at which I work, there is a privately-run HMO. There, the level defined as adequate is 20 ng/ml. I believe you and I know this level to be deficient. BTW–I do not utilize this HMO (unless under duress).

    I love my vitamin D, and I love my sunshine.

    🙂

    I feel best when my 25(OH)D level is at the higher end of optimal.

    But, too high is also not a good idea, imo.

    Peace,
    Rita

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