Diverticulosis is the condition of having outpouchings (diverticulae) of the colon develop as a result of chronic excess pressure on the colon wall. Three decades ago, it was virtually unheard of before age 40 or 50. Now although it is still more common with age, it’s seen occasionally in the 30’s. Symptoms include abdominal pain due to spasm (more common in the left lower abdomen), bloating, and changes in movements (both diarrhea and constipation can result). Any such symptoms would prompt a gastrointestinal work up to rule out more serious conditions. Occasionally bleeding can occur, and if the diverticulae become infected then diverticulitis results, which can lead to perforations and abscesses.

Risk factors for diverticulosis include increased age, chronic constipation, and a low fiber diet over decades. Fiber was first recognized in 1974 as being the most important factor in diverticulosis. Denis Burkitt was a general surgeon who practiced medicine in developing countries in Africa as part of missionary work. As a young doctor he expected to do a lot of abdominal surgery in these areas that didn’t have medical care prior to his arriving. For his entire career he operated on just a few people with appendicitis and diverticulitis, and those were Western workers who had only been in Africa for a brief time. In 1979 he published a book called “Don’t Forget Fiber in Your Diet,” and the rest is history; the major cause of diverticulosis was identified.

Definite diagnosis is relatively easy with the use of a CT scan or MRI, followed by a colonoscopy.

The recommended treatment depends on the symptoms. Many cases have minimal symptoms and require nothing more than a high-fiber diet. Fiber has been shown to reduce pressure in the colon. For decades the advice to avoid seeds in many vegetables and fruits was given; this was based on the theory that the seeds could get caught in the diverticula. This advice was never based on legitimate studies and now has been proven to be definitely erroneous; in fact these vegetables and fruits contain fiber that improves the condition. Recommended fiber sources include both insoluble fiber as in whole wheat products and vegetables, and soluble fiber as in fruits and oats. Don’t’ get tricked, many containers of food products mention fiber, but actually have an insignificant amount.

For acute flare-ups of abdominal pain, prescription anti-spasmotics and the old fashioned remedy of peppermint oil can be prescribed.

When infected, diverticulitis is treated with antibiotics and a low fiber diet (which puts the colon at rest). A liquid diet and antibiotics are used in outpatients. More serious cases require hospitalization, nothing by mouth, and intravenous antibiotics. In either case, two antibiotics are necessary to treat aerobic (requiring oxygen to multiply) and anaerobic (multiply without oxygen) bacteria. Augmentin and Cleocin are antibiotics commonly used in outpatients.

Absesses not cured by antibiotics, and uncontrolled bleeding are two indications requiring surgery to remove the affected area of the colon or drain the abscess. With stronger antibiotics available, surgery is required much less often than several decades ago.



revised December 18, 2010:

Breast cancer is the most common female cancer in the United States. There are many known risk factors contributing to breast cancer that have emerged from decades of debate and research. Heredity (including the BrCa1 and BrCa2 genes), certain types of diets (high fat and dairy), excess weight, alcohol, and hormone use are well-known proven risk factors. This will address specifically not those issues but the connection between vitamin D insufficiency and breast cancer.

In 2008 the results of a large prospective study were published and did receive a fair amount of publicity. Blood levels of 25-hydroxyvitamin D levels were obtained over six years from 1989 to 1995 from women at the time of the diagnosis of breast cancer. The follow-up on the outcome of the breast cancer occurred over an additional thirteen years. Participants were treated with standard drugs for their breast cancers, but were not treated for their vitamin D insufficiency. This was the first study that looked at how vitamin D levels affected the prognosis of breast cancer.

The results were striking. 24% of women with levels over 30 ng/dl were compared to the 38.5% with levels less than 20 ng/ml. Those with levels over 30 ng/ml were 73% less likely to die and 94% less likely to have their cancer recur during the 10 year period. This study gives us an idea of the potent anti-tumor effect of vitamin D on breast cancer.

It was not an accident that this research started in 1989. In that year the medical journal Lancet published a study showing that activated vitamin D (calcitriol) reduced the growth of breast cancer and killed breast cancer cells in animal research. It was found that women with vitamin D receptor-positive tumors had better prognoses than those with no vitamin D receptors. (Absence of vitamin D receptors in a tumor is an indication of prolonged vitamin D insufficiency). Vitamin D has since been found to have several other beneficial effects in fighting breast cancer cells. An inverse correlation with distance from the equator and breast cancer has also been documented (more sunlight, higher vitamin D levels, less breast cancer). In 2004 a study concluded that vitamin D reduced the number of abnormal mammograms;(many of those abnormalities were premalignant conditions).

Calcitriol is activated vitamin D and a very potent drug that is used in patients on dialysis and in patients who have had their parathyroid glands removed. It can be lifesaving in these conditions, but its major side effect is an elevated calcium level,(hypercalcemia), which can have serious consequences. In the 1990’s pharmaceutical companies tried to find analogues of vitamin D that would retain its ability to fight breast cancer, but at the same time not have the side effect of raising serum calcium levels found in calcitriol. I know this for a fact for three reasons. First, inside sources have reported it; second a close friend of a physician I know took a full-time job as a pharmaceutical researcher around this time for the purpose of discovering vitamin D analogues, and third, at a meeting of the American Society of Clinical Oncology in the mid-1990s I was an observer to a conversation of a very prominent nationally known breast cancer researcher who mentioned that pharmaceutical companies were working on finding vitamin D analogues for cancer prevention and treatment. (Unfortunately I did not understand the significance of this at the time.) The substance with the properties that the pharmaceutical companies were looking for already existed, Vitamin D3. However it is not patentable, therefore potential revenues from Vitamin D3 don’t justify private industry spending money on research and advertising.

There have been several studies since 1989 linking breast cancer incidence with low vitamin D levels. There has been much research showing that breast cancer cells are killed by activated vitamin D (and activated vitamin D increases when the level of vitamin D is sufficient.)

In 2009 there was a study that did receive some initial publicity. A study published in the Journal of the National Institutes of Health gave women only 400 units of vitamin D over many years. 400 units of vitamin D daily is a miniscule dose for an adult and has been shown to raise 25-hydroxyvitamin D levels by only about 5 ng/ml. Previous studies have shown that such a small increase doesn't prevent a significant number of fractures or breast cancer, and this was confirmed in the 2009 study. (Taking 400 units of vitamin D is like throwing a pebble in the ocean). A press release resulted in newspapers reporting the erroneous and dangerously misleading conclusion that “Vitamin D doesn’t prevent breast cancer.” The study showed nothing of the kind; the authors of the study didn’t claim it showed this, and unfortunately an opportunity was lost to spread this vital information about the importance of vitamin D. When an umpire makes a mistake a no-hitter may be lost. But when erroneous misleading press reports about a critical way to prevent breast cancer are published, lives are lost.


1. Have your doctor obtain a 25-hydroxyvitamin D level. Insurance that pays for lab tests should pay for this test just like any other blood test (if the correct diagnosis code is indicated).

2. Obtain a copy of the test results to verify the correct test has been done. (I have seen several instances of 1-25-dihydroxyvitamin D being done instead. This is a different test and is worthless in determining vitamin D sufficiency).

3. Take a vitamin D supplement to obtain vitamin D sufficiency within a few months. The lowest normal level of 25-hydroxyvitamin D is considered 32 ng/ml. 40 ng/ml has been shown to be more beneficial for bone strength and osteoporosis prevention. 52 ng/ml has been shown in a study to have additional benefit for breast cancer prevention. For perspective, it should be noted that male lifeguards in August not taking any vitamin D supplements nor using sun screen have levels of about 100 ng/ml. From sunlight alone, humans cannot attain a level over 150 ng/dl; chemicals in the skin break down at this level so no more vitamin D is produced. It has been documented that no side effects occur from 25-hydroxyvitamin D levels unless the levels are above 150 ng/ml.

4. Vitamin D3 is extremely inexpensive (5000 units daily cost $2 to $4 a month.) (Vegetarian prescription vitamin D2 can be prescribed by a physician for those who prefer). Vitamin D3 is the identical molecule that the human produces in the skin and absorbs in response to sunlight.

5. Levels of 32 ng/ml will lower the incidence of breast cancer. 52 ng/ml has been proven to be better. The evidence indicates that ideal levels are at least 60 to 80 ng/ml and perhaps "lifeguard levels" is what nature intended.

6. Most people are taking far too little vitamin D. Once vitamin D insufficiency is diagnosed, I recommend 5000 units a day with a repeat blood level in six months. In some cases, a higher dose is needed for temporary periods, but this should only be taken with the guidance of blood levels.


1. Follow the above recommendations for preventing breast cancer.

2. Because the situation is more urgent, a repeat blood level should be obtained in 3 months to determine if the dose is high enough.

3. 25-hydroxyvitamin D levels in females who have breast cancer are much lower than the general population. 80% of breast cancer patients have been shown to have low vitamin D levels in a number of studies. (I have tested about 150 breast cancer patients; 100% have had low levels). Levels less than 20/ng/dl are very common in women with breast cancer.

A substantial body of evidence and research dating back to 1989 indicates that vitamin D3 can prevent and treat breast cancer. Oncologists would be quick to point out that there isn’t the perfect long term double-blind control study, Some studies like that may be going on now. However, would you want to be the one that takes a placebo instead of a $2 a month pill that has no side effects and unquestionable lowers the dose of osteoporosis and fractures?


However, does this mean that advanced breast cancer can be simply cured by vitamin D. NO, noone is claiming that. In order for vitamin D to become activated, the cells of the human body converts it to "activated vitamin D."

It has been known for decades that early cancer is more sensitive to chemotherapy agents than advanced cells, presumably because there are more DNA mutations with each multiplication of the cancer cells.

In the same way, there are studies that suggest that advanced cancer produces substances that make it more difficult for 25-hydroxyvitamin D to be converted into activated vitamin D. This would stress even more the importance of health people obtaining an ideal vitamin D level BEFORE cancer deelops. In the future, studies may quantify more exactly the degree of resistance cancer cells have. It would not be surprising if this resistance is not all or none, but gradually increases as the cancer becomes more advanced.

I have seen another issue regarding treatment of breast cancer sometimes causing confusion. Vitamin D is not an antioxidant. Many oncologists advise their chemotherapy patients to refrain from antioxidants such as vitamin C and several of the B vitamins based on some research findings. This has NOTHING to do with Vitamin D.

Common sense may raise the question, “why doesn’t someone just treat breast cancer patients for their low levels of vitamin D to improve bone health?" Some women are already doing this. However it is rare.

Based on projections from studies, some vitamin D research physicians have predicted that if every female in America achieved a 25-hydroxyvitamin D level of even 40 ng./ml, the incidence of breast cancer would plummet 50% within five years.

Twenty-one years have elapsed since the first study linking vitamin D with breast cancer prevention and treatment. The time to take action is long overdue.

It should be noted that the most significant victory to date against breast cancer did not result from a chemotherapy agent, surgery, or radiation. It resulted from the dissemination of knowledge. As soon as it became widely known and publicized in the 1990’s that routine use of hormone replacement was a major risk factor in causing breast cancer, (and most of the reports of the benefits were simply untrue), women simply stopped taking hormone replacement and the incidence of breast cancer dropped 33% within a small number of years. In a similar way, the next significant victory in breast cancer could result in women becoming more proactive and following recommendations regarding achieving an ideal 25-hydroxyvitamin D level.



Vitamin D stimulates the production of antimicrobial peptides, a class of natural antibiotics. The antibacterial effect has been known for over a century. The best known example of this is the treatment of tuberculosis prior to the discovery of antibiotics. Patients were sent to sanitariums where they stayed outside on sunny porches during the day. The explanation of the beneficial effect wasn’t fully understood at the time. We now know that the increased sunlight led to increased production of vitamin D and led to some arrest or even cures of the tuberculosis because of the production of these anti-microbial peptides.

There have been reports in the past few years on the effect of vitamin D and influenza. 7) UPDATE ON VITAMIN D–2010 (from this web site) noted that the terrible pandemic of swine flu that lasted over a 2 year period “took the summer off” (when vitamin D levels were higher) before restarting. There is a well known story of an English long term care facility in which one ward of the entire facility had no cases of influenza during a flu epidemic. The physician in charge of that ward had given all his patients a significant dose of vitamin D daily.

For the first time, as published in the May, 2010 issue of the American Journal of Clinical Nutrition, a rigorously designed randomized, double-blind, controlled clinical trial evaluated the effect of vitamin D on seasonal influenza A. Over 4 months children were given either 1200 units of vitamin D or placebo. Each case of influenza A was confirmed with influenza antigen testing with a nose/throat swab. 18 of 167 children given vitamin D compared to 31 of 167 children given placebo were diagnosed with the flu. This represents a reduction of 41.9%. The reduction was even more prominent in those children that previously weren’t taking any vitamin D supplements (most American children aren’t). It should be stressed that this study was double blind, so that the medical personnel diagnosing the flu and doing the laboratory flu studies did not know which children took the placebo and which children took the vitamin D.

A second result of the vitamin D supplements was an 83% reduction of asthma attacks in children with a diagnosis of asthma. Positive effects of vitamin D and asthma have been widely reported in research studies over the past 5 years.

It should be noted that 25-hydroxy vitamin D levels weren’t obtained. Previous studies have reported that 70% of American children have low levels of 25-hydroxyvitamin D (less than 32 ng.) Many of the 167 children were probably so low that the 1200 units of vitamin D didn’t give them ideal or even normal levels of vitamin D. So the 41.9% reduction is a very conservative figure of the percentage of influenza that could be prevented by achieving ideal 25-hydroxyvitamin D levels.

And finally, it should be also emhasized that you probably didn't hear about this study until today. I found out about it by chance on the day I am writing this. This emphasizes that unfortunately we can NOT rely on the press to keep us informed of critically important medical studies.



Several months ago I posted a link to this newsletter on the NY Times online. Since then, the blog for this newsletter has been accessed by people from 40 states and 9 countries. Specifically entry #9, the report on complete remission of MS with vitamin D alone, has been accessed by a large number of people who have MS or know someone with MS.

Welcome to the members of the Fantastic Fifties of South Jersey, the Taproom Luncheon Club of Haddon Township, NJ, the Henry Raich Senior Group of Cherry Hill, NJ, the St. Mary's Breast Cancer Support Group of San Francisco, and members of other groups that visit this site. Tips of the hat go to my cousin in San Francisco and friends in Florida, Massachusetts,and South Jersey who are spreading the word about Vitamin D, As a result many more people who never would have heard the message have gotten tested and discovered they were Vitamin D insufficient.

Welcome to some of the 400 followers of http://www.twitter.com/robertbakermd
and http://www.twitter.com/VitaminDWebSite
who have clicked onto this blog.

This Health Newsletter is about a variety of subjects, but I want to stress Vitamin D here. The evidence continues to mount that the realization of the pandemic of Vitamin D insufficiency is the most important medical discovery in preventive medicine in at least 40 years..

Since I first said this in 2008 I have come to learn that I understated the benefit. Easily treated Vitamin D insufficiency is the most important medical discovery in preventive medicine in at least a century


Positive effects that vitamin D has on bones has been known for a long time. The connection with rickets (the ultimate bone weakening disease caused by profound vitamin D deficiencies in childhood) was discovered a century ago. The connection with osteoporosis wasn’t begun to be appreciated until late in the 20th century. It has only been in the last ten years that the strength of the connection has been appreciated. During this time the other non-bone effects of vitamin D have begun to be realized based on facts discovered by vitamin D research. (For a summary, see #7, Update of Vitamin D -2010.) A study published August 24, 2010, in the online version of Genome Research helps explain how one simple compound produced by the sun can have such a widespread effect.

The study used DNA technology to create a map of where Vitamin D receptors are in our genes. They found 2,776 binding sites for the vitamin D receptor. These sites were concentrated near genes associated with many autoimmune conditions such as MS, Crohn’s disease, lupus, rheumatoid arthritis, type I diabetes, and also various cancers. In all, this study showed that vitamin D had a significant effect on the activity of 229 genes. Compared to what is known about all other vitamins and other chemicals in the human body, these findings are profound. The importance of these findings is magnified by the appreciation that there is a pandemic of vitamin D deficiency worldwide due to insufficient exposure of humans to the sun. Studies have also shown that vitamin D levels in Americans are actually decreasing over the past 3 decades.

One of the authors of the study, Dr. Sreeram Ramagopalan, from the University of Oxford in Great Britain, has made critical observations about the meaning of this study. Vitamin D supplements during pregnancy and during infancy could have widespread beneficial effects on a child’s health later in life. (A study in Finland several decades ago showed correcting low levels with vitamin D supplements resulted in an incredible 85% reduction in the incidence of type I diabetes during childhood.)

Unfortunately the United States is behind in making full use of the last decade’s vitamin D discoveries. Dr. Ramagopalan makes the point that some countries such as France have taken steps to institute this as a routine public health measure.

What can you do? The recommendation that everyone should obtain a routine 25-hydroxyvitamin D level and correct any insufficiency is at least five years old, (and is still widely ignored). Spread the word to your friends and relatives, especially pregnant females,that they need to obtain a level and correct any insufficiency.



Vitamin D supplementation has just become main stream, standard therapy for MS.. The September, 2010, issue of Current Neurology and Neuroscience Reports (already posted on the internet), contains an article titled Multiple Sclerosis and Vitamin D: A Review and Recommendations, from the Department of Neurology, Oregon Health & Science University.It makes note that the risk of development of MS, as well as the disease severity, has been associated with Vitamin D in a variety of studies. Taking into account the current evidence, their recommendation is that vitamin D supplementation at dosing adequate to achieve normal levels appears reasonable.

In my previous article on an MS remission, #9, Lisa improved with the vitamin D but didn’t achieve a complete remission until her level was over 70 ng. Reminder, levels over this are present in most male lifeguards in August).

I have gone through the message boards of several MS organizations on the internet. Many MS patients are reporting that they are taking major doses of vitamin D, either on their own or on the recommendation of their neurologist, and have experienced lessening of symptoms.

It is unfortunate that this important recommendation won’t receive widespread publicity that it deserves. With the publishing of this medical journal article, neurologists are now on notice to obtain a 25-hydroxy vitamin D level on all their MS patients, and treat every low value, as part of standard care of MS.



A telomer is a region of repetitive DNA at the end of a chromosome which protects this area from deterioration. Chromosomes frequently deteriorate with age and telomers prevent this deterioration. If telomers becomes shorter as the cell ages, they can’t protect the chromosome as well.

As far as I can find, there has only been one study done measuring the length of telomers and correlating it with vitamin D levels. In the American Journal of Clinical Nutrition of November, 2007, the authors measured the length of telomers of white blood cells in women. Serum vitamin D concentration was positively associated with white blood cell telomer length.

Telomer length has been shown in other studies to be correlated with a lessened incidence of various cancers and increased cardiovascular health. And still other studies have shown increased longevity associated with higher vitamin D levels.



In the mid-1980’s, osteoporosis became a household word for the first time. It was described as deteriorated thinning bones common in aging. Because bones are made of primarily calcium, the theory was advanced that Americans are not eating enough calcium, and we should take high dose calcium supplements .This theory has been ingrained in Americans minds and accepted as the whole truth.

There are problems with this approach.

1. In “third world” countries, such as African countries prior to the 1960’s, osteoporosis was studied. Osteoporosis was extremely rare. The people in most of these countries drank no milk or ate other dairy food after infancy. Their total calcium intake was very small, mainly coming from fruits and vegetables. The dairy industry has supported this type of research with millions of dollars of grants. Vitamin D drastically increases the absorption of calcium that is taken in, so it makes sense that the calcium requirement is greatly reduced when the vitamin D level is ideal instead of insufficient.

2. The countries with the highest calcium intake per capita are the United States, Denmark, and Israel. The countries with the highest incidence of osteoporosis are the United States, Denmark, and Israel.

3. The Eskimos of North America have the highest incidence of osteoporosis in the world. They take in one of the highest amounts of calcium of any ethnic group. (With the Eskimos, it’s not from dairy, it’s from fish bones). If calcium was a significant factor, they would have among the lowest rate, not the highest rate.

4. And very importantly, the intake of calcium (in the form of supplement tablets) had greatly increased in the United States in the past 25 years. According to the calcium theory, the incidence of osteoporosis and osteoporotic fractures (age-adjusted) should have shown a significant decrease). Instead, it has greatly increased.

The effect on vitamin D on bones has been known for close to a century. Rickets was a disease of soft bones in children that was very common a century ago in the United States among children who were big city dwellers and didn’t get much sun exposure, It was discovered that giving infants 400 units of vitamin D will largely prevent rickets. The public health solution to this was to add 100 units of Vitamin D for every 8 oz. glass of milk. (There is practically no vitamin D in cow’s milk when it is fresh from the cow). It worked; 4 glasses a day (400 units) largely prevents rickets. The dairy industry has been promoting milk for over a century as a source of calcium and vitamin D. However 400 units of vitamin D prevent rickets but nothing else. It raises the vitamin D level an average of only 5 nanograms.

Another problem was that it was believe that the “normal” vitamin D level was 20 ng. This figure was arrived at simply by testing hundreds of “healthy” Americans and finding many fell within a range starting at 20 ng. (This same technique was used in the 1970-‘s in the determination of the “normal” cholesterol level in the 1970’s. Using this method, 250 mg. was determined to be the upper normal limit. It is well known now that this level is associated with a 400% increase in the incidence of heart attacks). It has only been in the last decade that the lowest normal level is considered to be 32 ng. (Labcorp lists 32 to 100 ng. as the normal range. Quest lists 30 to 80 ng., specifically listing 20 to 30 ng. as “insufficient.” Many early osteoporosis studies showed there was a high incidence of osteoporosis in people with vitamin D levels in the 20’s. The wrong conclusion was made that this means that vitamin D was a factor, but not an important factor, in osteoporosis. Reevaluating those hundreds of early studies, it’s now clear that osteoporosis is very rare with vitamin D levels of greater than 32 ng. In fact, studies have proven that bone density is greatest in people with levels over 40 ng. The facts point to the concept that the goal for people with osteoporosis should be at least 40 ng. (In my experience, 700 people with osteoporosis on DEXA scan have been tested; all but 4 of the 600 (99%) have levels less than 32 ng. (the 4 normal levels were in the low 30’s. Other physicians’ experiences (and large research studies) have found the same results.

In the past decade, it has become known that there is a pandemic of vitamin D insufficiency worldwide. This is attributed to living much further from the equator and wearing far more clothes than early humans, less sun exposure and the use of sunscreens (the latter two done in an effort to protect our skin from burning).

Many people are getting 25-hydroxy vitamin D levels ordered by their physicians. (The test is not ordered routinely and up until 5 years ago, virtually no one was getting tested except when ordered by a few pioneering physicians, mostly rheumatologists and the occasional endocrinologist). Now some primary care physicians are ordering it. Many are interpreting it correctly and treating with proper doses. Unfortunately others are not. The following case histories demonstrate this:

1) A 75 year old female suffered a hip fracture, spends a year in the nursing home, never getting a vitamin D level. Upon moving to this area I ordered a test on her; her level was less than 10 ng.

A word about fractures. It is believed that most fractures in the elderly are not the primary result of a fall. Frequently the bone snaps first, the person falls, and everything happens too quickly for the person to realize the pain occurred in the split second before the fall.

2) A 93 year old female suffered a fractured pelvis. Her level was 23 ng. Both these patients were undiagnosed and untreated prior to (and for a time after) their fractures. Shocking as it is, levels are not being obtained routinely on patients with osteoporosis by all physicians. (I have noticed that practically all rheumatologists are ordering the test, and some are treating deficiencies very aggressively).

3) In clinical practice, there is a growing number of physicians who routinely test. Many treat correctly and aggressively. Unfortunately many primary care physicians will test, and treat with insufficient doses for a few months, with no plan to get follow up levels in 6 months. Many physicians suffer from what has been described as “Vitamin D toxicity hysteria.” They feel that treating to a level of 40 or 80 ng. will cause toxicity that occurs when the level is over 150 ng. Scientific studies have shown that this cannot occur unless Vitamin D is taken in amounts over 20,000 units a day for an extended length of time. No physician would ever recommend this amount of vitamin D. A comparison can be made with water. If someone is foolish enough to drink several gallons of water a day, it can cause serious side effects. No one would ever say that because of this, humans should severely restrict their water intake.


1. It has been recommended now for years that everyone with osteorpososi (and in fact everyone in the United States) get a 25-hydroxy vitamin D level.

2. Treatment to an ideal level is recommended. The scientific evidence proves that treatment goal should be at least 40 ng., and many experts feel 60 to 80 ng. is a more ideal level. (The level found in nature in humans with a lot of sun exposure is over 100 ng. based on sunlight exposure alone). In the case of nursing home patients with fractures, it has been shown that major doses of vitamin D for insufficiency leads to less falls and fractures within 6 months.

3. The public health recommendations are for people who do not get levels. Frequently for adults the maximum is recommended at 2000 units daily. However giving a recommendation without a blood level is equivalent to treating someone with a blindfold on and having no information. I have had one case of a 40 year old female who walked outside 6 miles a day year round in South Jersey. She took no vitamin D supplements and ate little dairy. Her level from the sun alone was 110 ng. She represents one out of 2000 people. Projected to a population of 300 million people, there may be 150,000 Americans who have this level without taking vitamin D.

4. I cannot recommend a specific dose for someone without knowing their level. Out of the 2000 people tested, I have over 1500 low levels, and I have seen follow up levels on most of them. Many people have to take 5,000 to 10,000 units a day to reach an ideal level. However I am not recommending this dose to anyone without obtaining a blood level and then follow-up levels at 6 months. Booster doses can be recommended by a physician for a temporary period of several months to quickly get the level up toward ideal.

5. Vitamin D should not be confused with anti-oxidants, but frequently are. There were exaggerated claims made about anti-oxidants for several decades that were not based on valid scientific medical studies or blood levels; and now in fact the downside of too many anti-oxidants is being discussed. Tens of thousands of studies on vitamin D are extensive and proven.

6. Another difference between anti-oxidant vitamins and Vitamin D: Oncologists do not recommend anti-oxidants with chemotherapy because of interference with chemotherapy. In contrast. Over 80% of cancer patients have very low levels of vitamin D, and there is significant evidence that treating insufficiency will improve results of treatment.

7. The blood test is a simple non-fasting blood test. With the proper diagnosis and coding, my experience has been that all insurance companies that pay for blood tests pay for this one.

8. In many opinions, the failure to diagnose and treat vitamin D deficiency in the last 5 years on osteoporotic patients with fractures represents malpractice. The same applies to the failure of nursing home patients to receive a routine level. This is not a complicated medical issue; once the facts are defined, it’s common sense. Two sayings about common sense certainly apply: “Nothing astonishes mankind so much as common sense.” - Ralph Waldo Emerson. “Common sense is not so common.” – Voltaire.

9. The cost of osteoporosis especially among the elderly is a major public health problem, reaching the billions (and growing each decade even adjusted for age). The government and insurance companies would realize major savings by encouraging testing. Vitamin D Supplements are extremely inexpensive.



Lisa is a 43 year old lady who has graciously given me permission to share her remarkable story of her 16 year battle with multiple sclerosis.

Lisa started getting severe episodes of dizziness in 1994 at the age of 28. The symptoms occurred periodically and she was finally diagnosed by a neurologist in 2000with multiple sclerosis, proven by an MRI of the brain. Over the past decade she has experienced many episodes, and has been treated with intravenous steroids many times to quiet the inflammation. Four times in the last decade she developed acute episodes of extreme fatigue and muscle weakness, symptoms common with MS. Prior to 2006 she was on a variety of MS medicines, including daily injections of Copaxan for the MS, muscle relaxants, and Neurontin for neuropathic pain. Eventually she was tried on Avanex, an interferon-like drug. The Avanex never lessened her symptoms but did cause a great deal of side effects and made her feel quite sick. It is noted for causing flu like illness, causing her to take it very irregularly.

In 2005, I first learned about the connection between MS and Vitamin D. At my urging she obtained a 25-hydroxyvitamin D level. The result was 13 ng., which is a very low. She was started on 50,000 units of vitamin D a week and her level over the next year went up to 40 ng. She noticed a decline in symptoms and an increase in energy. By 2009 with adjustment of her vitamin D dosage, her level was now 70 ng. In mid-2009 she received another one of many MRI’s of the brain, and this one showed no worsening from the previous one done in 2007. (All previous MRI’s had always been getting progressively worse with more brain lesions). At the time of the 2009 MRI, her MS symptoms were no longer present. Lisa is totally free of symptoms for the first time in 2 decades.

Multiple sclerosis is an autoimmune disease. Studies show it has a genetic component, although most children of MS patients do not develop it. A geographic factor was noticed decades ago; studies showed that the MS rate in countries was higher the further away from the equator the country was (and therefore the lower the vitamin D levels were).

Dr. Roy Swank of Canada was a neurologist who worked at the Montreal Neurological Institute for decades. He published 30 year studies on the treatment of multiple sclerosis long before many drugs were available. His treatment showed a high incidence of arresting the multiple sclerosis, and consisted of minor modifications in the diet to reduce fat, and daily cod liver oil in an amount that contained about 800 units of Vitamin D3 (5600 units a week).

In the last few years, with the increasing recognition of the importance of vitamin D, one study showed 85% of subjects with MS improved with Vitamin D. Other studies show those an inverse relationship between vitamin D levels and MS. Geographic studies show the incidence of MS is correlated with distance from the equator.

Regarding Lisa’s case, it is important to notice that there was an initial decrease in symptoms as the level reached the 40’s, but a complete disappearance of symptoms didn’t occur until her level was about 70. (For comparison, most male lifeguards are over 100 ng.each August after several months in the sun).
Lisa had no lifestyle changes during the time of her improvement. Her improvement is one example of a complete remission of MS with Vitamin D alone.

I first heard of the connection of MS with sunlight over 3 decades ago. A search of the National MS Society and the MS Association of America web sites show that vitamin D articles are available to patients, but far too few MS patients have adequately treated their vitamin D insufficiency. In the past 5 years in South Jersey there are several prominent neurologists who are now testing their MS patients for vitamin D, and most likely this is occuring across the country.

Reportedly the first time a conection between Vitamin D and multiple sclerosis was made was in 1974 by Dr. P. Goldman in an article published in the International Journal of Environmental Studies, although the correlation of MS and distance from the equator was known before then. Over 3 1/2 decades have passed since then. It is time for neurologists, primary care doctors, and MS patients to act. Every MS patient should receive a 25-hydroxy vitamin D level routinely, and any insufficiency should be treated with a goal of maintaining an ideal level.

If you know a patient with MS, send this link to them.



Asthma is a disease of the small airways in the lungs that become over-reactive to a number of triggers. (Asthma has been described as “twitchy lungs.”) This can cause obstruction leading to cough, shortness of breath, chest tightness, and wheezing. Any new onset of wheezing should be evaluated by a physician as there are other causes, including cardiac problems. Over 1 in 20 Americans have been diagnosed with asthma. The prevalence of asthma has increased 61%, and death 31%, since 1980.

Multiple environmental factors contribute to asthma attacks. They include respiratory infections (bronchitis,sinusitis, and pneumonia), breathing in cold air, drinking cold liquids, humidity, dust, allergies especially to cats or other animals, GERD, emotional stress, ingesting sulfites added to food, and of course smoking and other inhaled irritants. Air pollution is certainly linked to asthma, but in spite of public misconceptions, because of clean air laws in the United States, the important types of gas and particulate pollution have been reduced 50 to 80% from 1970 to 2006.

Dietary factors have been neglected. Many studies using elimination diets have shown various food items can precipitate an asthma attack. Cow’s milk and dairy foods in general has been shown to be the worst offender. Peanut allergy has been well publicized but is far less common, and there is a long list of foods that affect some people occasionally. Beer, wine, and liquor contains histamine, the chemical that sets off allergy symptoms, and studies have verified this connection. Wine and beer also contain sulfites. Bologna, some hot dogs and other prepared meats also contain sulfites, and I remember the patient years ago who got a severe asthma attack every time he ate a bologna sandwich. A high fat diet fuels the inflammatory component of asthma. Vitamin D has been shown to lessen inflammation in asthma and enables steroids to work better. It has been shown that asthma medications lower vitamin D levels, therefore making the asthma worse. (2/3rds of us have vitamin D insufficiency if it hasn’t been diagnosed and treated).

Treatment usually starts with inhaled bronchodilators such as Albuteral on an as needed basis. This is an adrenaline type of drug and side effects include rapid heart rate and palpitations. Steroids (prednisone) are the most powerful dilators of bronchial tubes known, given either orally or by inhalation. Chronic oral steroids have well known side effects, but your doctor may prescribe frequently a 5 day course of Medrol dospak (a steroid) that does wonders for an asthma flare-up without the long term side effects. Inhaled steroids (sometimes given chronically in severe cases) also are very effective with a lower incidence of side effects. Intal by inhalation is an anti-inflammatory sometimes prescribed especially for children. Singulaire is a leukotrien antagonist (leukotriens are inflammatory white cells) and is a potent drug for lessening symptoms of allergies and asthma. Long acting Albuteral type inhalers are also useful, some in combination with inhaled steroids.

Even though most asthma should be able to be controlled or even cured, the statistics remain sobering. Elimination diets are often effective but under recommended. Any asthmatic can try it themselves by eliminating one class of common foods for several weeks, and see the results. Eliminate any obvious triggers, and dairy is the first class of foods that should be tried.

Why should the incidence and death rate from asthma be so much higher just since 1980? Smoking and air pollution are decreased. But changing diets more likely to worsen asthma and lower vitamin D levels now compared to 30 years ago are the most likely explanations.



(Revised 9/20/10 with the addition of the information on heart failure.)

Last year’s update on vitamin D mentioned studies that documented various benefits of correcting the recently recognized pandemic of vitamin D insufficiency. There have been additional dozens of important studies since the 2009 update. However instead of writing about the individual studies, this column will give an overview of vitamin D and will try to answer the question, “How can one substance have so many beneficial effects on humans?”

First, vitamin D is not a vitamin. A vitamin is something that is supplied to humans from food. Vitamin D is not supplied by food in a significant amount, it is produced in the skin by sunlight. There is NO vitamin D naturally found in cow’s milk; the practice of adding 100 units to every 8 oz. of cow’s milk started almost a century ago was done to stop rickets in children. This dose does prevent rickets, but does little else. 400 units of Vitamin D a day only raises the level 5 nanograms (ng). Most Americans have levels that are 10 to 20 ng. below the “normal” level of 32 ng. and way below an ideal level, We’ve all seen people with high levels of vitamin D. Lifeguards in August have levels frequently have levels over 100 ng.

Vitamin D increases calcium absorption taken in from the diet. With insufficiency, only 10-20% of calcium is absorbed. With proper vitamin D levels, 60-80% of calcium is absorbed. Since calcium goes to the bones, this explains the prevention of rickets. However now it is known that virtually all osteoporosis is associated with a level of vitamin D below 32 ng. Prior to 10 years ago, almost every study done on osteoporosis used a dose of 400 units a day, and most showed no effect on osteoporosis or fractures. As late as a few years ago, newspapers trumpeted the wrong information that vitamin D didn’t prevent fractures. However all studies using larger doses of vitamin D have shown a large reduction in fractures. In fact, one critical study showed that large doses given to elderly hip fracture patients reduced further fractures and reduced falls within 6 months. (Muscles also contain vitamin D receptors and correction of insufficiencies increases muscle strength in the elderly).

Hyper-proliferation of cells is what occurs with cancer. Vitamin D has repeatedly been shown to prevent this. Many large studies have now shown that various types of cancers are associated with very low vitamin D levels. In a well publicized cancer study that spanned 8 years, the lowest levels of vitamin D were associated with the worst outcome and highest mortality in breast cancer. Many other studies have measured vitamin D in various types of cancer, and the results have always shown lower levels with the cancer. One study showed the incidence of breast cancer continued to decrease up to levels of 52 ng. Some vitamin D experts have predicted that the breast cancer rate would be reduced 50% if every woman’s vitamin D level was only 40 ng. Similar studies exist with prostate cancer and colon cancer. PSA levels in prostate cancer were shown to decrease with Vitamin D over 20 years ago. Thyroid cancer cells stop multiplying in a test tube when vitamin D is added. Lung cancer in smokers is less common the higher the vitamin D level, and in fact prognosis is better with higher vitamin D levels once lung cancer occurs. No one should misunderstand this data; it does not invalidate the many known causes of some various cancers. It is simply a factor that prevents the formation of a cancer in the presence of various known causes.

It was known in the 1970’s that MS and juvenile diabetes were less common the closer to the equator (more sunlight, more vitamin D). A study in Finland showed that giving a large number of infants high doses of vitamin D cut down the incidence of juvenile diabetes by a remarkable 80% a decade later. A recent study showed an 85% improvement in MS. These diseases, along with rheumatoid arthritis, lupus, and many other autoimmune diseases,involve cells within the body becoming modified by unknown factors and attacking the body, causing the illness. Vitamin D has been shown to keep our important immune system normal, and prevent any harmful changes to it.

Vitamin D has been shown to stimulate the production of antimicrobial peptides, a class of natural antibiotics. These have activity against bacteria and viruses. Think about it; why do flu epidemics occur during the winter and not the summer? Why do these epidemics occur in June and July in the southern hemispheres where the seasons are reversed? (Answer -lower vitamin D levels). In fact, the horrible pandemic of swine flu epidemic in the few years before 1920 tapered off in the summer before restarting. There are many published studies demonstrating this property of vitamin D.

Vitamin D levels have been shown to correlate with survival many years after bypass surgery.

In September, 2010, an 8 year study showed that deaths from heart failure were 3.4 times higher in patients with vitamin D levels less than 20 ng. and 2.0 times higher with levels 20 to 29 ng. vs.>30 ng.

Although much more research is being done, the existing research is convincing and totally unlike the anti-oxidant research (Vitamin C and B's)that has been called into question. Granted, it sounds too good to be true. Vitamin D is very inexpensive, so there are no advertising budgets to help spread the word. Vitamin D could have a profound effect on health care expenditures; it has been called a national health care plan in itself. It makes sense that Vitamin D is so basic to life and health. Scientists agree that life began near the equator. Early humans had unlimited access to sunlight, and didn’t have sunscreen or a wardrobe, so at one time humans’ vitamin D levels were very high.

The understanding of the importance of Vitamin D remains the most important preventive medicine development in over a century.



GERD is a common condition caused by gastric acid reflux into the esophagus. This irritates the esophagus and frequently causes heartburn and other symptoms including belching, coughing, wheezing, heartburn, nausea, vomiting, regurgitation of food, rarely hoarseness, and even occasionally major gastrointestinal bleeding. The chest pain can sometimes simulate symptoms of a heart attack, and on occasion a sufferer ends up spending several days in a coronary care unit before a heart attack is ruled out. On the other hand, I have run into cases of individuals self-medicating with over the counter drugs for GERD, but later it turned out it was angina and a precursor for a heart attack. Hiatal hernia, (a condition in which part of the stomach moves above the abdomen) can also pecipitate symptoms.

Basic common sense treatments for GERD that have been used for decades include avoiding food that commonly causes symptoms. (common precipitators of pain include chocolate, spicy foods such as pizza, caffeine, alcohol, and even peppermint), avoiding aspirin and Motrin type drugs (as they can increase gastric acid), avoiding lying down after meals, sleeping with the head of the bed elevated, taking all medicines with a 8 ounces of water, and even weight reduction (which reduces intra-abdominal pressure that pushes up on the stomach).

Many drugs can worsen symptoms including anticholinergics for seasickness, beta blockers and calcium channel blockers for hypertension and heart disease, bronchodilators for asthma, some Parkinson drugs, sedatives, and tricyclic antidepressants. However if you suspect you’re being affected, don’t stop the medicine on your own; talk it over with your doctor.

Tests to confirm diagnosis range from barium swallow x-ray to upper GI endoscopy by a gastroenterologist. A stool guaiac test (for blood) is a good idea, but is underused.

Occasionally GERD can have serious complications. Chronic exposure of the lower esophagus to acid sometimes transforms the normal esophageal cells to abnormal cells called “Barrett’s esophagus”. These cells have a small but definite risk of turning into cancer.

Treatments of GERD: Antacids such as Maalox, Mylanta, and Tums neutralize stomach acid and usually provide quick relief. Side effects include diarrhea or constipation. Milk used to be recommended to neutralize acid. It does relieve pain temporarily, but results in an acid rebound, and is not recommended.

H-2 receptor blockers such as Tagamet, Pepcid, Axid, and Zantac reduce acid production. They don’t work as quickly as antacids but provide longer relief. Side effects are rare but Tagamet can sometimes act as an anti-androgen, so men should choose an alternative drug.

Proton pump inhibitors block acid production and allow the damaged esophageal tissue to heal. PPI’s include Prevacid, Prilosec, Nexium (the famous little purple pill), Protonix, and Aciphex. In the test tube, all PPI’s are equal, but many people feel that one of them consistently work better than the others. I wish I could tell you side effects are rare, but there is one underpublicized serious effect. Several years ago it was discovered that chronic maintenance use of PPI’s decreases calcium absorption and is associated with an increase in hip fractures in young people. Many Fantastic Fifties members are aware of the pandemic of vitamin D deficiency present in North America. Use of PPI’s is another reason to get a 25-hydroxyvitamin D level, and aggressively correct low levels with supplements. The vitamin D would increase calcium absorption and help counteract this side effect of the PPI’s.

Medications to strengthen the muscular barrier between the esophagus and stomach are occasionally used in severe cases. Surgery is used only in the most intractable cases, but is frequently unsuccessful.

The generics of these drugs for GERD are very inexpensive. For example, some of the OTC PPI’s can be obtained for $6 a month. Treatment should result in a relief of symptoms in almost all cases.