Robert Baker MD Health Newsletter

27) MYASTHENIA GRAVIS ASSOCIATION AND VITAMIN D

2012-01-15T09:02:00.000-08:00

The Myasthenia Gravis association has a web site and a discussion blog online. It can easily be accessed by goggle: Myasthenia Gravis Association.

My entry on this Health Letter #19 is titled: Case History: Subjective and Objective Improvement in Myasthenia Gravis following aggressive treatment of Vitamin D insufficiency. It tells the story about Debbie, a woman with myasthenia gravis.

This entry was different than when I wrote about other illnesses, such as osteoporosis and multiple sclerosis, which have a significant amount of medical research supporting their connection with vitamin D. I was unable to find any medical study that investigated myasthenia gravis(MG) and vitamin D. However myasthenia gravis is known to be an autoimmune illness felt to be caused by abnormal antibodies, and there has been much research done on vitamin D having a beneficial effect against such antibodies.

I precipitated a discussion of Vitamin D and myasthenia. Many members of the forum with MG were aware that they had very low levels of vitamin D, and were aware of the problems that can arise with osteoporosis, made worse because prednisone frequently used to treat MG often accelerates osteoporosis. One member in particular felt there was a possibility that an improvement in the MG that coincided with taking significant doses of vitamin D were related. Some members of the forum indicated they were going to get a 25-hydroxyvitamin D level done for the first time.

One member of the forum summarized the discussion on the Myasthenia Gravis Forum:

"I think Dr Baker has been given a good hearing on this Forum and his argument has been well made. Maybe it’s time to let it sink in. And .. I have taken what he says about vitamin D deficiency very seriously. I think there may well be something in it and think it worthy of further investigation. The MS (Multiple Sclerosis) Trust and MS Society have taken on board the possible link with vitamin D deficiency and autoimmune diseases and I think we should too."

Best wishes to the members of the forum who suffer from MG and I hope as a result of the discussion, more people with MG have an experience with vitamin D that is similar to that of Debbie's positive experience.

#26) ANTICANCER RESEARCH ARTICLE FINALLY GETS SOME PUBLICITY

2011-12-17T19:04:00.000-08:00

I have made several references to the fact that there has been no publicity in newspapers about the recent landmark crucial study that proved that a blood level of 25-hydroxyvitamin D of 47 ng. will slash the incidence of breast cancer in women 50%.
Earlier this week I was emailed by a friend of mine in Lowell, Massachusetts, about an article in the Lowell Sun newspaper. (I grew up in Lowell).The article interviewed a non-physician non-researcher who quoted the thoroughly discredited Institute of Medicine report of about a year ago. I wrote a letter to the editor setting the record straight, and it was published today. I mentioned in the letter the Anticancer Research article. The letter is below.
The circulation of the Lowell Sun is over 100,000. So finally there has been some publicity about this study.
You don't have to read the Lowell Sun to know about the study. You know about it now.

Vitamin D has benefit
The Lowell Sun
Updated: 12/17/2011

The conclusions of "Popping vitamin D? Not so fast" seem to be based on the Institute of Medicine's report of late 2010, which has been criticized by many vitamin D experts, including the Harvard School of Public Health.

The ability of adequate vitamin D levels to prevent osteoporotic fractures has long been proven with medical studies. Symptoms of many illnesses are lessened by ideal vitamin D levels. Recently, the September 2011 issue of the medical research journal Anticancer Research demonstrated beyond any doubt that a serum level of 47 mg. of 25-hydroxyvitamin D resulted in a 50 percent lower risk of breast cancer. This study got practically no publicity in newspapers.

I have ordered more than 6,000 25-hydroxyvitamin D levels in seven years, and treated more than 4,000 individuals with insufficiency. The benefits I have seen are too numerous to list in this letter.

ROBERT BAKER, M.D.
(Lowell High School graduate)
Cherry Hill, N.J.

Although I still can't find any other newspaper that makes reference to the 47 ng. level vitamin D study, I have found other publications that write about the details of the study. Just a few of them are:

1) Foodforbreastcancer.com
2. People Beating Cancer
3. MND (Men's News Daily)

#25) MORE VITAMIN D: (WHO WANTS TO GET OSTEOPOROSIS?)

2011-10-27T16:34:00.000-07:00

Vitamin D remains underused and not fully understood by many people. This column will review news and information regarding vitamin D.

Osteoporosis remains a multi-billion dollar health problem. For 15 years calcium and a small dose of vitamin D were recommended, but studies have shown this is insufficient. It is now known that levels of Vitamin D over 32 ng (and preferably over 50 ng)) will prevent most osteoporosis. At the same time, amounts of 400 units of vitamin D have been shown repeatedly to have practically no benefit. 800 Units a day is only slightly better. Obtaining several thousand vitamin D levels from people in the last 7 years have given me the opportunity to compare this experience with the research studies. About 400 levels had osteoporosis or osteopenia on a DEXA scan. Of these 400, only 3 people have had levels less than 32 ng. (less than 1%). So want to prevent osteoporosis? (who doesn’t?). Get your doctor to order a 25-hydroxyvitamin D level (it’s still not done routinely), and get the level up to over 32 ng.-preferably over 40 ng, 50 ng. if even better. With these levels, most of the calcium you eat in your diet will now be absorbed (80% instead of 15%). The few populations that do have levels this high (and don’t take calcium supplements) have a very low level of osteoporosis. How important is this? How many people do you know over 70 that have broken a hip? Mostly it’s not a case of falling and breaking a hip. It’s been shown that often the hip breaks spontaneously and the person falls, and everything happens so quickly the person doesn’t realize the pain came a split second before the fall.

Cedrick and Frank Garland are two scientists/doctors who went to a lecture in the 1980’s as students where they learned that the amount of sunlight is strongly related to the incidence of a number of cancers. They devoted several years to research the subject, and they changed history. They published their data in the 1990’s, and this is the reason you have heard so much about vitamin D in the newspapers the past 7 years; a great deal of further research was stimulated by this. Breast, prostate, and colon cancer have been most studied and the proof is substantial that the incidence of these cancers can be greatly decreased with higher vitamin D levels. A critical “earth shattering” study was just published a few months ago. The only 12 studies on vitamin D levels and breast cancer were combined and it was determined that if a woman maintains a level of over 47 ng. of vitamin D, her chance of breast cancer is reduced by 50%. This is the type of information that we should have read on front pages of newspapers, but unfortunately in medical research, sometimes the most important discoveries get the least publicity. It is estimated that this 50% reduction in breast cancer could occur within 5 years.

Late last year the important sounding Institute of Medicine came out with a report on Vitamin D in which they admitted they were disregarding every major study Vitamin D study done in the past 15 years. They tried to make the case that vitamin D was “no big deal.” Since then this has become the most repudiated document I have seen in my career. Every true vitamin D expert in the country has specifically pointed out why it is invalid. The Harvard School of Public Health proved point by point that the study was a collection of wrong conclusions based on no evidence or incorrect evidence. The Endocrine Society disagrees with the report. Many other prominent organizations have repudiated it. As far as the motivation of the committee members, that’s a very long story, but suffice it to say that most of the members had financial interests in industries who stand to be hurt if the population increases their vitamin D level. For instance, a pharmaceutical company has been working over a decade on new Vitamin D ”look-alike” drugs that can be patented. If they ever succeed, it would only be a financial success if the general population doesn’t take vitamin D on their own. Some people who authored the report had financial interests in this company. (I don’t make this stuff up, I only tell you about it). One person has told me she heard that Vitamin D is “controversial.” There is no honest controversy involved with vitamin D. It should be noted that Vitamin D has absolutely nothing to do with Vitamin E, which has recently again been publicized as having a negative effect on good health. Vitamin E NEVER had any valid studies backing up its use as a supplement.

I’ve written about many other benefits of vitamin D in the previous updates. From the research that’s been published, and reinforced by follow up levels in the people I have on vitamin D, in order to reach a level of 47 ng. of higher, it is often necessary to take 5000 Units of Vitamin D daily. (available for $2 a month over the counter). I often am told that some people are still taking a dose far lower than this. The often talked about dose of 2000 units a day is something that some organizations have recommended for people who never have had a blood test.I recommend blood levels for everyone. I only occasionally see someone who attains an adequate level at the lower 2000 unit dose.

So my final question is this: What are you waiting for?

#24) SUBJECTIVE & OBJECTIVE IMPROVEMENT IN RHEUMATOID ARTHRITIS WITH VITAMIN D

2011-09-21T10:37:00.000-07:00

Rheumatoid arthritis is one of the most common autoimmune connective tissue diseases. However it is far less common than osteoarthritis, which commonly occurs with age. (Although several factors are involved in the genesis of osteoarthritis, it is the “wear and tear” arthritis.)

A blood test, the rheumatoid factor, correlates with the severity of the rheumatoid arthritis, and is a measure of the antibody activity.

Precipitating factors are multiple and have been known for decades. Some cases are simply allergies to certain foods – milk and other dairy products have been proven to be the major factor in some cases that have gone away with abstinence from dairy foods. However the precipitating factors have not been embraced by the medical industry, and few sufferers of rheumatoid arthritis have even tried a dairy free diet nor are they told about it.

Because of research that has been done in the past decade, it has been shown that correction of a vitamin D insufficiency lowers the production of abnormal antibodies in autoimmune diseases.

Mrs. X is a 55 year old female who was diagnosed with rheumatoid arthritis in February, 2005. Her rheumatoid factor was 23. In July, 2009, she obtained a vitamin D level for the first time, and it was low at 21 ng. She was treated with 5000 units of vitamin D daily. In April, 2011, she reported that there had been a significant improvement in her joint pain and stiffness, and her repeat vitamin D level was 31 (still low, but much better than 21), and her rheumatoid factor was down to 18, a 22% decrease. No other changes in her medications had been made during that 4 year time span.

Poorly publicized medical studies have shown improvements in rheumatoid arthritis with treatment of vitamin D insufficiency. In this case, the individual had not yet reached anything close to an ideal level of vitamin D, it can be speculated that she may continue to improve with a higher level. The drop in the rheumatoid factor with vitamin D alone indicates a 22% decrease in antibody activity.

#23) PREVENTION OF BREAST CANCER WITH VITAMIN D HAS BEEN QUANTIFIED; A LEVEL OF 47 NG REDUCES THE RISK BY 50%.

2011-09-11T05:03:00.000-07:00

What are you waiting for?

It has been known for many years that vitamin D prevents hyper-proliferation of cells in the human body. Research has shown that actual breast cancer responds in a test tube to activated vitamin D. But can vitamin D PREVENT breast cancer? A study just published in the September 2011 issue of Anticancer Research answers that question clearly.

There are 11 case-control studies on the risk of breast cancer by 25-hydroxyvitamin D levels that have been published. The authors of this meta-analysis combined the data to relate the risk of breast cancer to 25-hydroxyvitamin D levels.

The study confirmed the connection. This meta-analysis provides proof. A serum level of 47 ng. resulted in a 50% lower risk of breast cancer.

The studies did not determine the maximal beneficial effort of vitamin D on preventing breast cancer. It would be expected that the prevention of breast cancer would keep increasing with a higher level of vitamin D above 47 ng. Vitamin D levels in nature are higher than 47.

The study also did not look at the treatment of established breast cancer with vitamin D.

Do many women have a blood level of 47 ng of vitamin D? I have obtained about 4000 blood levels of 25-hydroxyvitamin D in men and women over the past 7 years, mostly people from Southern New Jersey but also some from California, Florida, Massachusetts, Rhode Island, and Texas were included. Only a very occasional person has that high a level. One woman who gardened all summer had a level of 70 ng. One woman who walked 6 miles a day all year round was quite memorable; she had a level of 110 ng. A fisherman had a level of 60 ng. I’ve seen less than 20 people who had a level of 47 ng or higher without taking a major dose of vitamin D. About 2/3rds of men and women have very low vitamin D levels below 32 ng.

In order to obtain a level of 47 ng, most people need to take at least 5000 units of vitamin D daily. Only occasionally do some people require less. The well publicized dose of 2000 units a day is intended for people who are healthy, and who have never obtained a blood level. In most cases, it will not raise a level below 32 ng to 47 ng. I’ve seen many people who already take 2000 units a day who have levels below 32 ng.

There are several breast cancer fund raising organizations that raise many millions of dollars to cure breast cancer. Much of the money is used for research grants to cancer researchers. I have seen their spokespeople on television, and they have made it clear they are not interesting in devoting their efforts to PREVENTION. They have no plans to publicize studies such as these.

If there was one well publicized “RACE FOR PREVENTION” publicizing the facts in this study, instead of the usual “RACE FOR THE CURE”, more women would be saved from breast cancer over 5 years than have been helped by chemotherapy since 1974, the year that the “War on Cancer” started.

Although this particular study was done on breast cancer, there are extensive somewhat similar studies done on men with prostate cancer. There are also many studies done with various type of cancers including cancer of the uterus and pancreas.

In a perfect world, this medical study should be publicized in newspapers and television news. As so often happens, unfortunately it will most like not be publicized.

#22) VENUS WILLIAMS HAS SJOGREN'S SYNDROME

2011-09-02T19:37:00.000-07:00

Riddle:

Question: What does Venus Williams and Sjogren's have to do with Vitamin D?

Answer: Everything

Sjogren’s syndrome is an autoimmune illness involving dry mouth, dry eyes, joint pain and inflammation, and fatigue. It is considered incurable. It is in the class of rheumatological diseases such as rheumatoid arthritis and systemic lupus. It is a rare disease.

A study was published in the Annals of Rheumatic Diseases in which vitamin D levels were measured in 35 patients with Sjogren’s syndrome and normal controls. This study was done because of other previous studies that suggested that Vitamin D may have a regulatory role in the immune system.

The results were clear cut. Severely diminished blood concentrations of vitamin D was found in patients with Sjogren’s syndrome compared to those without Sjogren’s.

In some cases of Sjogren’s, a harmful antibody called IgM rheumatoid factor is found. In this study,patients who did have an elevated level of IgM rheumatoid factor, there was a significant correlation with vitamin D – the higher the harmful levels of IgM rheumatoid factor, the lower the vitamin D level.

Venus Williams has been diagnosed with Sjogren’s syndrome. It forced her to withdraw from the U.S. tennis open. The media is reporting that she had symptoms for over a year.

The initial studies on vitamin D were the first and second steps. The next step is taking a number of patients with Sjogren’s syndrome, treating half of the subjects with major doses of vitamin D, and half with placebo. When is this study going to be done, now that the preliminary studies have been done.

There are problems. The initial study mentioned above on vitamin D was published in 1983; the one published in the Annals of Rheumatic Diseases was published in 1990. I have reviewed MEDLINE and have found NO studies treating Sjogren’s with vitamin D; not even a case report.

It looks like there is never going to be a proper study to evaluate vitamin D in Sjogren’s. Every person with Sjogren’s should obtain a 25-hydroxyvitamin D level and treat with vitamin D supplements to an ideal level. We know that the vitamin D will have a positive effect on bone density, along with many other beneficial effects. It hasn’t been studied in people with Sjogren’s sufferers. Because it’s over the counter, what’s stopping anyone with Sjogren’s from taking it to evaluate the effect on their Sjogren’s. Vitamin D has been shown to lead to improvements in other autoimmune diseases - rheumatoid arthritis, multiple sclerosis. What would happen if it ended up being a very effective inexpensive treatment for Sjogren's?

Do you hear me, Venus?

#21) A MAJOR ADVANCE IN MULTIPLE SCLEROSIS

2011-08-01T16:00:00.000-07:00

Multiple sclerosis is a serious illness. Almost everyone knows someone personally who has multiple sclerosis. Many remember Annette Funicello, the unfortunate case in which Annette has been wheelchair bound for many years.

Multiple sclerosis is an autoimmune disease in which abnormal antibodies are produced that attack the central nervous system. It is believed that many factors contribute to these antibodies being produced – genetics, (although parent-child cases or cases in two siblings are very rare), dietary factors, and other factors have been researched with various degrees of proof.

In 1974 Dr. P. Goldman published a medical article in the International Journal of Environmental Studies which noted a very strong connection between higher rates of MS and distance from the equator. How this could affect the incidence of MS was not understood at the time, and it has taken over 3 decades for scientific discoveries to catch up and explain this connection.

Because of medical research done in the last decades, it is now known that vitamin D in the human can decrease or eliminate the production of abnormal antibodies produced when the human body turns on itself. Vitamin D is produced almost exclusively from the sun’s action on our skin. (Very little vitamin D is added to milk, and it’s present in some other foods such as fish, but there is not enough in food to supply the human body with the amount it needs.) Connecting the dots of this research done over 3 decades explains the sun connection. Distance from the equator is strongly correlated to the amount of vitamin D produced by humans.

There are over 350 studies of vitamin D and multiple sclerosis listed in MEDLINE. They approach the subject in dozens of various ways. Vitamin D levels are in general very low in patients with MS; higher levels in childhood and adulthood lead to a lower incidence of MS; vitamin D is shown to modify the harmful antibodies; and most importantly, giving vitamin D to MS sufferers shows improvements in the symptoms and objective positive changes in a high percentage of cases. One article summarizes the studies: “Vitamin D: a natural inhibitor of multiple sclerosis.” Another article asks: “Managing MS – are we forgetting something?” Another article finds evidence that vitamin D should be given prenatally to expectant mothers, and to infants, to prevent a variety of illnesses. One research study shows an improvement in 80% in MS patients with vitamin D. And finally a well respected neurological journal in 2010 has recommended that every MS patient get a 25-hydroxyvitamin D level, and deficiencies should be treated. Vitamin D is now mainstream medical treatment for MS.

There are a number of powerful medications used to treat MS with varying results, varying side effects, and they tend to be extremely expensive. Neurologists are the experts on these drugs. Vitamin D should be used as an additional treatment with virtually everyone with MS. It costs a few dollars a month, and at the doses involved, is free of side effects. All the treatments of MS strive to prevent further antibody damage; unfortunately nothing has been found that regenerates the nerve cells that have already been irreversibly damaged. So no one is claiming that wheelchair bound people could walk again, but further damage may be prevented.

I started off by saying that almost everyone knows someone with MS – a friend, or relative. If that is the case with you, tell them about these findings. I still come across people who suffer from MS, and in one case, die from it, without ever having had a vitamin D level drawn or without receiving vitamin D. This has got to stop!

#20) INDEX FOR VITAMIN D ARTICLES

2011-05-17T23:48:00.000-07:00

Welcome to the members of Cherry Hill Chamber of Commerce, who on May 19th were interested in asking about vitamin D especially with it's connection with multiple sclerosis.

#2) UPDATE ON VITAMIN D 2009 - 5/1/09

#7) UPDATE ON VITAMIN D 2010 - 6/1/10

#9) CASE HISTORY-COMPLETE REMISSION OF 16 YEARS
OF PROGRESSIVE MS WITH VITAMIN D - 7/1/10

#11) VITAMIN D, TELEMERES, LONGEVITY - 7/7/10

#12) UPDATE ON MULTIPLE SCLEROSIS AND VITAMIN D - 7/24/10

#13) GENES AND VITAMIN D, HOW VITAMIN D HAS SUCH A
WIDESPREAD EFFECT ON HUMANS - 9/1/10

#14) PREVENTION OF INFLUENZA WITH VITAMIN D - 9/12/10

#15) BREAST CANCER AND VITAMIN D - 9/20/10

#17) MARKED IMPROVEMENT OF OSTEOPENIA AND OSTEOPOSIS ON DEXA SCANS WITH VITAMIN D ALONE OVER 5 YEARS,4 MONTHS - 4/5/11

#18) UPDATE ON VITAMIN D 2011 - 5/1/11

#19) CASE HISTORY – SUBJECTIVE AND OBJECTIVE
IMPROVEMENT IN MYESTHENIA GRAVIS - 5/11/11

#21) A MAJOR ADVANCE IN MULTIPLE SCLEROSIS - 8/1/11

#22) VENUS WILLIAMS HAS SJOGREN'S SYNDROME - 9/2/11

#23) PREVENTION OF BREAST CANCER WITH VITAMIN D HAS BEEN QUANTIFIED; A LEVEL OF 47 NG

#24) SUBJECTIVE 7 OBJECTIVE IMPROVEMENT IN RHEUMATOID ARTHRITIS WITH VITAMIN D REDUCES THE RISK BY 50%

#19) CASE HISTORY:SUBJECTIVE AND OBJECTIVE IMPROVEMENT IN MYASTHENIA GRAVIS FOLLOWING AGRESSIVE TREATMENT OF VITAMIN D INSUFFICIENCY

2011-05-11T18:18:00.000-07:00

Myasthenia gravis (MG) is a rare autoimmune disease in which the body produces antibodies against the receptor that transmits chemicals from the nerves to the muscle. It is believed that these antibodies are produced by the thymus gland, and often excessive lymphoid tissue (similar to that found in lymph nodes) are found in the thymus glands of myasthenia patients. (Lymphoid tissue consists of cells that produce antibodies). Celebrities sometime define rare disease to the public. In this case, Aristotle Onasis (Jackie Kennedy’s second husband) suffered from it and in fact eventually died from it's complications.

Debbie is a patient who was diagnosed with MG in 2001 at the age of 41. She was getting frequent infections and suffered from increasing weakness. Her primary doctor referred her to a neurologist, who did a series of tests including the tensilon test; and myasthenia gravis was diagnosed. She was treated at various times with prednisone, immuran, and mestinon, with some positive results.

From early on she suffered from intermittent double vision, common in MG. She wasn’t able to drive because of her fear of suddenly getting the vision problem. This greatly affected the quality of her life.

She was first seen by me in November, 2008. I told her at that time there is no medical research on MG and vitamin D, but many other autoimmune diseases are benefited by vitamin D, and the positive effects of vitamin D on the immune system in other autoimmune diseases have been studied.

Debbie’s vitamin D level then was 22 ng/ml. I convinced her to take a significant dose of vitamin D and her level increased to 64 ng/ml on July 15, 2009. She noticed improvement in her symptoms within a few months of starting the vitamin D. In a stunning development, the double vision that had plagued her for 7 years was gone and has not returned; she has been able to resume driving. She noticed a decrease in her frequent infections and increase in muscle strength. In general she felt much better. Her dose of prednisone was cut significantly because of the improvement. However she then decreased her vitamin D dose, her level dropped in a few months to 57, and she noticed the beginning of the return of many of her symptoms. In January, 2011, I saw her again and encouraged her to increase the dose of her vitamin D to maintain a level that approaches what I call the “lifeguard level.” (Full time male lifeguards in August frequently have levels of 60 to 80 ng. or even higher.)

I have reviewed MEDLINE and done internet searches and cannot find any research that has been done on vitamin D and myasthenia gravis. If anyone who is reading this knows of any, please let me know. I have gone to patient support web sites and have found many patients blogging that their vitamin D level was extremely low (10 to 20 ng./ml seems to be common), but most of them take small doses of 1000 to 2000 units a day in an attempt to correct it, and many have a hard time raising their level significantly. One lone woman noted on the blog that since taking vitamin D, her double vision stopped and hasn’t returned over many months.

It is felt that myasthenia involves an ongoing antibody reaction and the damage to the muscles could be reversible if the antibody production can be stopped. The evidence indicates that vitamin D affects the immune system in a beneficial way, and can prevent the body from producing cells that attack itself.

A study of treating MG patients with significant doses of vitamin D and measuring their muscle strength with objective tests needs to be done. Whether this will be done in 1 year, or 20 years, I don’t know. MG patients shouldn’t wait. In the mean time, Debbie’s quality of life has increased and her need for some medications that cause significant side effects has decreased. I cannot find any report in medical literature that a person with MG took vitamin D not only to prevent osteoporosis but to see if there was a positive effect on the MG.

I will be posting this link on various patient support web sites for myasthenia gravis. I thank Debbie for allowing me to post her story in order to help other myasthenia gravis patients.

#18) UPDATE ON VITAMIN D - 2011

2011-05-01T08:00:00.000-07:00

It has been two years since my first update on Vitamin D. Research on vitamin D has continued to explode in this time. I see about 3 major articles a week that have been published on vitamin D. Rarely do the important studies make the newspapers.

One of vitamin D’s most basic properties is increasing calcium absorption, bone density, and muscle strength. Studies have shown that it’s never too late to be beneficial; in double blind studies elderly nursing home patients decrease their falls and fractures within 6 months of being given a significant dose of vitamin D. Studies show that bone density at 40 ng is better than at lower levels. I have collected several case histories in which people have increased their bone density by 15% on vitamin D alone over a few years. In 6 years of my ordering vitamin D levels, only 4 out of 700 (1 out of 175) had osteoporosis or osteopenia with an initial level of vitamin D over 32 ng (and all 4 were just barely over 32). Other physicians I have spoken to have seen the same results. Conclusion: want to have almost complete protection against osteoporosis? Keep your vitamin D level over 32 ng. (although 40 ng or higher would be better). (see #17 on osteoporosis).

My 2010 update listed information about vitamin D preventing hyper-proliferation of cells, and therefore cancer. A landmark study has been published specifically on breast cancer and the results were nothing short of incredible. Women diagnosed with breast cancer with vitamin D levels over 30 ng. were 73% less likely to die and 94% less likely to have their cancer recur compared to those with levels less than 20 ng. during the 10 year length of the study. The evidence in other studies indicate that if the vitamin D level is raised with supplements after the diagnosis of breast cancer is made, the prognosis will improve substantially. (see #15 on breast cancer for details of the study.

It has been shown that vitamin D prevents autoimmune disease by interfering with the production of abnormal antibodies that attack the body. Extensive studies have shown that the incidence of type I diabetes (juvenile), and multiple sclerosis can be greatly decreased by giving infants vitamin D. Many research articles on MS have shown improvements in the progress of the disease with vitamin D. My MS patients are few since I’m not a neurologist, but I’ve seen improvement in my several patients with MS who have their low level treated. (see #9 and #12 on multiple sclerosis).

Vitamin D allows the body to make a class of natural antibotics. In the May,2010
issue of the American Journal of Clinical Nutrition, a rigorously designed randomized, double blind, controlled study gave children either vitamin D or placebo during the flu season. The diagnosis of influenza A was made only when it was confirmed by culture. The vitamin D children had 42% less influenza A than the placebo children. An unexpected result was that the vitamin D children had an 83% reduction in asthma attacks. Previous studies have shown that 70% of children have vitamin D levels of less than 32 ng., and that the average vitamin D level is 20% lower in this decade than when we were children. (see #14 on influenza).

The findings on vitamin D sound “too good to be true” In the past several decades there has been wild claims about vitamin C and E that were known by some to be inaccurate shortly after they were published. There was always a great deal of skepticism by experts and there was never a consensus. In contrast. the vitamin D studies are extensive and accurate. An international consortium of vitamin D experts in a worldwide vitamin D call to action on March 31, 2011.

Should it be a surprise that vitamin D has such a profound effect on humans? The human body has about 2000 genes. A study in the August, 2010, Genome Research explained that vitamin D has been identified as having a significant effect on the activity of 229 genes (about 10%) by binding to 2776 sites on these genes. Humans have gone through periods of time of food shortages, but for a very long time humans had a very much higher level of vitamin D, as there was never a shortage of this near the equator.

#17) MARKED IMPROVEMENT OF OSTEOPENIA AND OSTEOPOROSIS ON DEXA SCANS WITH VITAMIN D ALONE OVER 5 YEARS 4 MONTHS

2011-04-05T05:12:00.000-07:00

Dory is a lady who in May, 2005, at the age of 50, received her first DEXA scan as a screening test for osteoporosis. After her initial test she was told by her physician there were areas of osteoporosis and osteopenia in the scan. No treatment was recommended at that time. Her physician’s plan was to repeat the DEXA scan in 2 years. The DEXA scan and the 2 subsequent scans were obtained at Massachusetts General Hospital in Boston.

Dory and her husband are acquaintances of mine. So they called me to get another opinion on the scan. I recommended to Dory that she obtain a 25-hydroxyvitamin D level. Her first level was in the low 20’s. I initially recommended she take 5000 units of vitamin D and repeat the level in 6 months.

2 years and 2 months later Dory got her second DEXA. It showed improvement in most of the bone densities tested. Her Massachusetts General Hospital physician was surprised that the bone strength had improved without taking any prescription anti-osteoporosis drugs. By then Dory was noticing that she felt so much better since taking the vitamin D, and noticed the increased strength and growth in her fingernails. I discussed with her the ideal level of vitamin D, told her about the high levels that lifeguards and fishermen and women have in the summers. She has adjusted her dose in the last few years and she has reached what many vitamin D experts consider an ideal level of 70 to 90 ng, and she has kept her level at that number.

Almost 3 years later, in September, 2010, she received her third DEXA scan. All areas tested were very much improved.

Dory’s Dexa Results -

Improvement in Bone Density
May, 2005 to September, 2010 (5 years, 4 month interval)
(L refers to lumbar vertebrae).

Hip-----Femur----L1------L2-------L3--------L4-----Ave.Increase
7.5%-----13.5%----33.6%--13.3%--22.2%--8.13%----17%

Dory’s documented results are quite remarkable. The public (and many doctors) feel it’s inevitable that bone density decrease with age.

Are these results unique? Studies haven’t studied serial bone density in subjects taking vitamin D alone in the absence of anti-osteoporosis prescription drugs. I have seen 2 additional patients in the past 5 years and both had improvements of 15% taking vitamin D alone in DEXAs taken two years apart.

History of Vitamin D and osteoporosis

Sunlight (which produces vitamin D in the skin) was discovered in 1850 to prevent rickets, and cod liver oil (which contains vitamin D) was recognized as preventing rickets in 1877. Rickets is a severe malformation of the bones occurring in young children. Vitamin D itself wasn’t discovered until 1922. Rickets continued to be common well until the 20th century.

It wasn’t until 1970 that Vitamin D’s role in calcium regulation was recognized. For several decades vitamin D was considered to be just one of many minor risk factors in osteoporosis. The medical profession repeated its error that had been made with cholesterol (in 1978 cholesterol of 250 mg. was considered normal). Similarly a 25-hydroxyvitamin D level was considered normal from 20 to 30 ng/ml. This led, erroneously, to minimizing of the importance of vitamin D as a cause of osteoporosis. Ordering 25-hydroxyvitamin D levels, stimulated by the release of research reports, didn’t become common until about 2005. It has only been since about 2005 that laboratories no longer report a normal level starting at 20 ng. Even today, many people even with osteoporotic fractures don’t get a level ordered. I know of many extreme cases; including a case in which a woman with a hip fracture at 75 stayed in a nursing home for a year without a level being obtained, suffering increasing weakness and falls, and then being discovered to have an level of 8 ng once she was out of the nursing home.

A most remarkable and very sad case of osteoporosis was a 70 year old woman who I saw in 2005, only a few months after I started ordering levels. She walked totally bent over at the waist with her upper body at a 90% angle to the floor. This type of thing has shown to be caused by microscopic fractures that occur over decades that start at a young age. I ordered a vitamin D level, her first ever. Out of the over 3000 levels I have ordered before and since, it is the only one in which the result was “no detectable vitamin D.” Unfortunately the vitamin D she now takes, although it has relieved some of her pain, can not completely rebuild and straighten her broken spine.

Many studies until recently showed that osteoporosis was common with what was called normal levels of 25-hydroxyvitamin D 20 to 30 ng/mg. Even to this day, studies are published and reported to the public in newspapers falsely claiming that vitamin D doesn’t prevent fractures because of the fractures that occur with levels in the 20’s.. For example, it has been shown repeatedly in studies that 400 units a day of vitamin D raises the level only an average of 5 ng,, and doesn’t significantly reduced the fracture rate. The truth is that in the last decade virtually EVERY study done comparing fracture rate above and below 32 ng has shown a significant reduction in fracture rates.

A landmark study in elderly patients from age 70 to 90 showed that in less than six months the number of falls and fractured decreased very significantly with very significant doses of vitamin D that raised the level, often over 40 ng. (Vitamin D was compared to placebo). Hundreds of well designed studies have demonstrated an extreme benefit of significant doses of vitamin D in terms of preventing osteoporosis).

Studies have shown that the parathyroid glands can have a detrimental effect on bone density up to a level of vitamin D of 40 ng. (The parathyroid glands produce their hormone to dissolve microscopic areas of bone in order to maintain a normal calcium level. A further beneficial effect with higher levels has not been studied, simply because not enough people have these higher levels. Many vitamin D experts consider an ideal level as 70 to 90 ng. Levels of vitamin D with sun exposure alone will not go up greater than 150 ng. At that level, there is a feedback mechanism which breaks down the chemicals in the skin that synthesize vitamin D.

No side effects occur with vitamin D at levels below 150 ng. There is a very specific situation in the rare disease of saroidosis and a few other illnesses in which the disease causes of disorder of vitamin D metabolism, so there is sometimes a hypersensitivity to vitamin D in these few rare cases that can be easily managed by monitoring blood chemistries.

Many studies have shown that taking calcium supplements increase the rate of kidney stones. Because these supplements are given with Vitamin D, some studies have erroneously concluded that vitamin D also raises the incidence of kidney stones. The truth is that all studies using vitamin D alone have NEVER shown an increase in kidney stones. In fact, with low vitamin D levels leading to an increase in calcium released from the bone, it is likely that treating vitamin D insufficiency leads to a DECREASE, not an INCREASE, in the rate of kidney stones.

Conclusions from my Clinical Practice:

I have obtained 3,500 25-hydroxyvitamin D levels on patients since 2005. About 700 of these patients had the diagnosis of osteoporosis or osteopenia on DEXA scan or examination. 697 out of 700 (99.57%) of these people had initial levels of less than 32 ng. Out the 3 with levels above 32 ng., one female had an oophorectomy in her 40’s, and all 3 had levels below 36 ng. Rheumatologists at a major medical center in NJ have had similar results testing everyone with osteopenia or osteoporosis.

Osteoporosis is a multi-billion dollar public health problem that is largely and inexpensively preventable.

DEFNITIONS:

All references to vitamin D levels refer to 25-hydroxyvitamin D.
All vitamin D measurements above are ng/ml. Some medical research uses the measurement nmol/L.

Conversion:
25-hydroxyvitamin D in ng/ml multiplied by 2.5 = nmol/L.
25-hydroxyvitamin D in nmol/L multiplied by 0.4 = ng/ml.

example: 25-hydroxyvitamin D: 40 ng/ml = 100 nmol/L.

DEXA scan is an x-ray test for bone density used to diagnose osteoporosis or osteopenia. It has become popular only in the past 10 years.

#16) DIVERTICULOSIS

2010-10-02T13:08:00.000-07:00

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.

#15) BREAST CANCER AND VITAMIN D

2010-09-20T15:10:00.000-07:00

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.

VITAMIN D RECOMMENDATIONS FOR ANY FEMALE FOR PREVENTING BREAST CANCER:

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.

VITAMIN D RECOMMENDATIONS FOR ANY FEMALE WHO HAS BEEN DIAGNOSED WITH BREAST CANCER

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?

FOLLOWING PARAGRAPH ADDED DECEMBER 18, 2010:

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.

14) PREVENTION OF INFLUENZA WITH VITAMIN D

2010-09-12T05:06:00.000-07:00

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.

WELCOME TO NEW READERS

2010-09-01T03:19:00.000-07:00

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

13) GENES AND VITAMIN D; HOW VITAMIN D HAS SUCH A WIDESPREAD EFFECT ON HUMANS

2010-09-01T02:18:00.000-07:00

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.

12) UPDATE ON MULTIPLE SCLEROSIS AND VITAMIN D

2010-07-24T06:21:00.000-07:00

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.

11) VITAMIN D, TELEMERS, LONGEVITY, CARDIOVASCULAR HEALTH, AND LOWERED CANCER INCIDENCE

2010-07-07T08:53:00.000-07:00

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.

10) OSTEOPOROSIS 2010

2010-07-05T10:07:00.000-07:00

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.

Recommendations:

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.

9) CASE HISTORY - COMPLETE REMISSION OF 16 YEARS OF PROGRESSIVE MS WITH VITAMIN D

2010-07-01T23:22:00.000-07:00

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.

8) ASTHMA

2010-06-01T10:07:00.000-07:00

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.

7) UPDATE ON VITAMIN D - 2010

2010-05-01T07:03:00.000-07:00

(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.

6) TREATMENT OF GERD (GASTROESOPHAGEAL REFLUX DISEASE)

2010-02-01T16:55:00.000-08:00

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.

WELCOME TO NEW READERS

2009-11-03T04:35:00.001-08:00

First, some people may be coming to this web site to read "Getting Vitamin D Results." The web site is http://GettingVitaminDResults.blogspot.com. To view the article, it's necessary to copy and paste it on your browser. An easier way is to just goggle "Getting Vitamin D Results," but it has to be in quotation marks. The link for the article should appear on top of the list.

As of July 29, 2010, the blog for this newsletter has been accessed by people from 40 states and 17 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

5. TREATMENT OF HIGH CHOLESTEROL

2009-11-01T11:56:00.000-08:00

MEDICAL TREATMENT OF HIGH CHOLESTEROL

High cholesterol is present in a high % of American adults. Lowering the LDL cholesterol has been proven in many studies to greatly cut the incidence of illnesses caused by atherosclerosis,such as heart attacks, some strokes, and peripheral artery disease. It does this by preventing the formation, progression, and even causing regression, of atherosclerosis. The goal should be an LDL cholesterol of less than 100 mg.,and in diabetics and those that have already have atherosclerosis, a better goal is less than 75 mg.

Statins inhibit the formation of cholesterol, and are the most effective drugs in lowering cholesterol. They also lower triglycerides somewhat. Frequently companies claim superiority of their product, but all statins are effective and generally well tolerated. The main side effects are well known. Less than 1 person out of 200 develops muscle soreness and weakness, which is reversed quickly with stopping the medicine. Rarely when the medication is continued in spite of these warning signs, more serious side effects occur. Probably everyone has heard that statins can affect the liver. Less than 2% of people taking higher doses of statins develop elevated liver enzymes, which also is quickly reversed by stopping the medicine. It’s recommended that liver enzymes be rechecked after 3 months of treatment, and yearly after; however in practice most doctors test more frequently. Statins that are available now are Mevacor (Lovastatin), Lipitor, Lescol, Pravachol, Crestor, and Zocor (Simvastatin). The dose of various statins varies.

Fibric Acid Derivatives (Lopid and Tricor) lower triglycerides usually 25% to 50%. Triglycerides are a different fat in the blood that is also a risk factor for atherosclerosis and is frequently treated at levels over 300 mg. High triglycerides are especially more common in diabetes. Adverse effects are rare. Lopid, although less expensive than Tricor, can rarely cause gallstones. Both of these drugs have shown a reduction in heart attacks in those that have elevated triglycerides.

Niacin (nicotinic acid) has a favorable effect on LDL cholesterol, triglycerides, and increases HDL cholesterol (the good cholesterol) as much as 35%. Niacin can cause skin flushing and itching, which is a very annoying side effect that keeps it from being used more often. Extended release niacin and taking an aspirin or Advil before a dose sometimes reduces the side effects. In my experience in practice, niacin is a difficult drug to take because of the flushing.
Zetia prevents the absorption of cholesterol that we eat in our diet. A combination of Zetia and Simastatin (Zocor) is available as Vytorin. It lowers LDL cholesterol up to 65%, and is often very effective when people are resistant to a statin alone.

Before statins were available in 1987, resins like Questran, Colestid , and Welchol were used These drugs bind bile acids in the intestine, and increase clearance of cholesterol from the blood. They can lower LDL cholesterol by 20%. Severe constipation is a side effect that prevents more widespread use.

Fish oil (omega-3’s) can decrease triglycerides up to 50%, and have many other beneficial effects. It is available over the counter, or in the form of Lovaza. Patients often buy fish oil capsules and take 1 or 2 a day; they are underdosing. 2 to 4.8 grams of omega 3’s is considered a therapeutic dose. If you take fish oil, discuss the dose with your doctor.

The combination of long acting niacin and lovastatin (Mevacor) is available as Advicor.

Statins are the drugs of first choice for most people with a problem of elevated cholesterol. They can decrease coronary events and deaths, and are a major reason why the incidence of heart attacks has gone down in the United States over the past few decades. Several of the statins are on the generic drug lists of Walmart, Target, Walgreens, and Wegmans; so they are very affordable.

THE NON-DRUG TREATMENT OF HIGH CHOLESTEROL

The non-drug treatments of elevated cholesterol are many. Virtually all newborns are born with a blood cholesterol of less than 150 mg, and it is a “rich diet” in combination with genetics that elevates the values as we get older.

Loss of excess weight, control of diabetes, and physical activity can lower cholesterol and triglyceride values. Adequate treatment of hypothyroidism can lower an elevated cholesterol. Cholesterol responds to reduction in dietary fat and cholesterol; triglycerides respond quite well to decreasing intakes of fat, sugar, and alcohol.

Both dietary cholesterol and dietary fat raise the serum cholesterol. Don’t be tricked by food labeling; some foods are labeled low in fat but are high in cholesterol, and vice versa. Egg yolks are very high in cholesterol, whereas potato chips are high in fat. Some special interest industries have falsely promoted over the years the idea that their products are part of a healthy diet. The egg industry in particular has financed research considered “junk science” by medical authorities. Egg yolks raise cholesterol, no matter that quantity or type of egg. Cow’s milk and most meats are very high in fat, ranging frequently from 50 to 80%.

Both soluble and insoluble fiber products lower cholesterol. One study showed that eating oatmeal 3 times a week for 6 months lowers cholesterol 10%, however that means no butter in the oatmeal. Bran products provide insoluble fibers, however bran muffins are often mixed with much fat, negating the positive effects. Fruits and vegetables provide soluble fiber (although fruits should be limited to 2 a day in the treatment of elevated triglyceride).

Adjuncts to dietary therapy can be included. Psyllium in doses of 5 grams twice a day, oat bran, pectin, and guar gum, can produce a 5-10% decrease in LDL cholesterol.

The 30% fat promoted by the American Heart Association for decades has been shown in studies to lead to no significant drop in cholesterol. Another words, it doesn’t work. 20% fat diets have a significant effect on lowering cholesterol. The Pritikin regression diet, the McDougall diet, and the Ornish diet, all high carbohydrate, low fat (HCLF diets), all less than 10% fat, have a major effect in achieving reductions of total cholesterol below 150 mg, and LDL cholesterol (bad cholesterol) below 100 mg. Nathan Pritikin published scientific studies in the 1970's showing that 85% of type II diabetics on oral medication and 50% on insulin can be off those medications within one month on the Prikin regression diet, and the figures remained similar at one year follow up. Dr. Dean Ornish published studies using cardiac cathaterizations showing that atherosclerosis in the coronary arteries can regress on the Ornish program. (Both programs include daily exercise, and the Ornish program includes relaxation anti-stress techniques).

These diets can be difficult to adhere to in the age of convenience stores and eating out. I have seen cases of a cholesterol level of 300 mg. dropping to 200 mg. in one month on this type of diet. The terms “high carbohydrate” if very misleading. They require almost exclusively complex, not simple carbohydrates and are also high in soluble and insoluble fibers. Many published studies publish misleading conclusions by comparing the Adkins diet (high in protein, low in all carbohydrates), or the Mediterranean diet (high in olive oil) with a diet that is high in all kinds of carbohydrates, complex and sugars, and then erroneously draw the conclusion that they are superior to the HCLF diet. There have been accusations and evidence that some of these misleading studies have been financed by the olive oil manufacturers.

In the 1960’s, the concept of lowering cholesterol by eating a lot of polyunsaturated fats (vegetable oils) was promoted by the American Heart Association. The studies showed it lowered cholesterol only 10% but increased the incidence of various cancers. Some of these fats we now know as “trans-fats” and they have gone from being recommended by health authorities to being banned in many areas. Nathan Pritikin was an early voice in pointing this out to the public in the 1970’s that substituting vegetable oils for saturated oils doesn’t work.
Vegetarian diets tend to be lower in fat or cholesterol SOMETIMES. Some vegetarians eat a lot of oils and dairy products, which negate the beneficial effects.

Olive Oil: Olive oil is a monounsatured fat, different from the polyunsaturated and saturated fats. There is evidence that it is better than saturated or poluunsastured fats. However in a direct comparison with true HCLF diets, they are second best.

Adkins diet: The debate about the Adkins diet goes back almost 4 decades. Dr. Adkins got a lot of attention when he promoted his products by saying you can eat all the eggs and butter, etc. you wanted. Although the Adkins diet does allow significant amounts of fat and is high protein, it severely restricts simple sugars, sharing in common an important characteristic of the HCLF diets. The publicity associated with the Adkins diet often says eat all the meat you want. The actual Adkins program as detailed in the various books gives examples of dinner meals consisting of 4 or 5 ounces of chicken or fish, and very insignificant amounts of whipped cream included in desserts. By eliminating ALL simple sugars, the diet is also eliminating a lot of products that are very high not only in fats but in salt – cakes, pies, cookies, etc. So the initial success of the Adkins diet is due to eliminating most sugar and a lot of fat from the diet, despite its reputation as a high fat diet. A lot of the initial weight loss is water weight because of the reduction in salt. Short term total cholesterol can be reduced; long term it depends on what type of foods one eats on the Adkins diet. If one truly eats large amounts of meat and fat, that type of diet has been proven rerpeatedly to be unhealthy in terms of both atherosclerosis and cancer. Long term studies of the Adkins diet and weight loss are not convincing.

Vegan or Vegetarian diets: In general, vegetarians and vegans have lower cholesterols and lower atherosclerosis disease rates than non-vegetarians and vegans. It really depends on the degree of adherence. If the diet includes more oils than the non-vegetarian or vegan, the benefit of the diet is partly negated. The inclusion of dairy products by some vegetarians is a story in itself. Of the HCLF diets mentioned above, the McDougal diet is a very low fat vegan diet with the addition of no oils and very limited sugars. The Ornish and Pritikin regression diet approaches this type of diet, but does include relatively small amounts of non-vegan products.

WHAT DOESN’T WORK:

Cutting down to 3 eggs a week doesn’t work. An egg contains over 225 mg. of cholesterol. Decades ago a cardiologist in Richmond, Virginia, experimented on himself and drew daily cholesterol levels while eating 6 eggs a day. There was a 50 mg. increase in cholesterol within a few weeks, at which point he quit the study. I know about this because he was my instructor in medical school.

Substituting polyunsatured fats (as the American Heart Association recommended for a few decades) not only doesn’t work; it causes an increase in cancer. This was known in the early 1970’s. To this day, a significant portion of the public thinks polyunsaturated fats such as various vegetable fats are healthy.

Cutting fat but continuing to eat high amounts of simple sugars will prevent weight loss and tends to keep the cholesterol level up.

GENETIC CONDITIONS AND CHOLESTEROL

One in 500 Americans have a gene for dominant hypercholesterolemia. This frequently leads to cholesterol levels of over 300 mg, and if not corrected, a high incidence of atherosclerosis and heart attacks. Studies have shown that the gene does interact with diet. Their grandparents may have had levels in the 200’s, whereas they have levels in the 300’s. If a person has a double dose of the gene (usually one from each parent), a very rare condition, his or her cholesterol can exceed 1000, and yes, it does interact with the diet, but other measures have to be taken to prevent early illness.

IT "ONLY" TOOK 6 DECADES

The pathologist Dr. Aniltsichkow first discovered that role of cholesterol in atherosclerosis in 1914. His studies were prominently published in Germany. In spite of that, it took 6 decades to receive increasing attention, to the point now that many heart attacks are now avoided by lowering cholesterol levels.
The scientist Nathan Prikin accelerated this awareness in the 1970’s with his research.

Conclusion: The scientific discoveries about atherosclerosis first made in 1914 are now proven beyond any doubt. The potential remains that most atherosclerosis, a leading cause of death, can be prevented.

Vitamin D Quiz #2

2009-10-10T10:55:00.001-07:00

Vitamin D Facts #2 » Fun Trivia Maker

Vitamin D Quiz #1

2009-10-10T10:08:00.000-07:00

http://vitaminddeficiency.blogspot.com/2009/10/vitamin-d-facts-and-fallacies.html

Take a 3 minute quiz on vitamin D; know more than most medical personnel about Vitamin D. It's necessary to copy and past the above internet address.

4. VITAMIN D AND PREVENTIVE MEDICINE

2009-10-01T06:17:00.000-07:00

With the national debating health care, there has been much talk on "preventive medicine."

Well, how's this for preventive medicine? Would this be good for the country? The rate of breast cancer, prostate cancer, and colon cancer drops 30 to 50% in 5 years (2014) at the cost of $5 a month.

Early humans lived near the equator, didn't wear many clothes, and didn't go to the nearest CVS for sunscreen. Noone was low in Vitamin D (it is made by sunlight). It is so prevelent that at least 20% of the genes rely on it to function (although as they do more research, that figure rises). Without a sufficient level, calcium isn't absorbed sufficiently (result - osteoporosis), cells hyperproliferate -(result - cancer) and inflammatory cells hyperproliferate (result - autoimmune diseases - MS, lupus, rheumatoid arthritis, type I diabetes). Also a natural class of antibiotics made by the body does't get produced. With all the concern about swine flu this season, I have read many studies with evidence that a level of Vitamin D of at least 50 nanograms lessens the chance greatly of contracting seasonal and Swine(H1N1)flu.

If we don't live near the equator,(north of Georgia, practically no vitamin D can be made 8 months of the year), we wear a lot more clothes, and we use sunscreen or don't go out much in the sun during the summer. (I'm not advocating we do sunbathe - skin cancer interacts with many factors such as Westernized diet, early humans didn't get skin cancer, Americans do). In fact, levels didn't just drop over thousands of years; a recent study proved that levels have dropped 20% nanograms in just 28 years in the United States.

After 20 years of being in primary care practice and never ordering a vitamin D level (noone else did), I have been surprised since 2005 as to what I didn't know. It involves tested 1700 people so far for 25-hydroxyvitamin D, and finding out first hand that virtually everyone with osteoporosis or osteopenia has a low level, 90% of people who had gotten various types of cancer have a low level, practically all people with lupus, MS, type I diabetes.. And the levels aren't just low, they are VERY low. Oh yes, 70% of normal healthy people also have low levels.

This information in no ways changes what we already know about the many risk factors for various cancers. If an individual has the risk factors and genetics in place putting them at risk for cancer, then low Vitamin D is the "straw that broke the camel's back."

And everything I found has been discovered by medical researchers in the last 15 years (85% of all Vitamin D research has been done in that time period.

So as researchers and vitamin D experts have said - wave a magic wand and make everyone's vitamin D level 32 nanograms ----- that would eliminate 50% of these diseases.

Although there has been much progress in awareness the past 5 years, there are several problems holding the progress back.

1) doctors and various aspects of the medical profession stand to lose a lot of income.
2) at $5 a month, noone is in line to make a lot of money from people taking vitamin D. Vitamin D3 available in vitamin stores is the same vitamin D, the same molecule that is made by the sun. (prescription Vitamin D2 is available for vegetarians).
3) just the act of testing vitamin D along with the routine blood work is a pain for doctors, because it means calling back 70% of patients and explaining to them they need to take vitamin D.
4) the enemies of vitamin D and preventive medicine (and yes, there are enemies) promote "Vitamin D toxicity derangement syndrome" (VDTDS). Toxicity can occur at levels greater than 200 nanograms. Those levels are impossible to obtain unless very enormous amounts of Vitamin D are taken over at least 8 months. No side effects occur at less than 200 nanograms. Unfounded fear of this keeps many people from taking sufficient vitamin D.

The actual "normal level" is considered 32 to 100 nanograms (as per Labcorp and others), but experts note that maximal bone density requires a level of 40 nanograms, and increased anti-cancer effect has been noted at 52 nanograms. These experts recommend an ideal level of 50 to 80 nanograms.

Full time male lifeguards have had their level tested at the end of the summer. Their levels are 100 ng. (and think about it - that would mean this is the level that humans had for thousands of years). Not coincidentally, this is the maximal level the body can reach by sun alone. After this level is reached, the chemicals break down and the level doesn't go any higher.

Vitamin promoters have "cried wolf" several times over the past 3 decades. Vitamin C was supposed to cure cancer, vitamin E was supposed to prevent heart disease. These claims were never based on valid research; and many were outright fradulent. The evidence of Vitamin D's connection in preventing these various diseases is greater than the evidence that cigarette smoking is a main cause of lung cancer.

The 4 step program for "recovery":

1. insist that your doctor order a 25-hydroxy vitamin D level. It is covered by insurance like any other blood test; it is non-fasting. Many insurance companies pay the laboratory a negotiated rate of about $50. Don't assume your doctor has already gotten if for you along with other tests. If he or she didn't specifically tell you what your vitamin D level was, he or she didn't get the test.

2. insist on getting a copy of the written results. Don't rely on anyone telling you "it's normal." (In New Jersey, the law states a person can request a copy of the results be sent to them from the laboratory).

3. decide what level you want. Minimal "normal" is 32 nanograms. Ideal is 50 to 80 nanograms. There levels can be reached within a maximal of 6 months. Remember, the average lifeguard in August has a level of over 100 ng.) Levels can be repeated in 6 months and then perhaps once a year to ensure the level is high enough.

4. Without a level, it's impossible to recommend the correct dose for a particular person. More people are taking Vitamin D than 2005, but most of those people are taking small insufficient doses that won't get the level up to even 32 ng.

4. don't look back, look forward. Most people's worlds would be different if everyone had known about this 20 years ago, (I know mine would be) but gong forward is what we have to emphasize.

WHAT INSURANCE COMPANIES COULD DO NOW TO EASE THE HEALTH CARE CRISIS

Some pilot programs have given discounts for maintaining a good cholesterol level, or a certain weight. The programs are working! Insurance companies could announce a pilot program offering discounts of 5% off the health care insurance premium if the customer produces proof that their total 25-hydroxyvitamin D level is 32 nanograms. I predict what would happen is that the insurance companies would find out within a few years that the discount could be increased as they would save far more than 5%. (Osteoporosis alone is a multi-billion health care cost).

Links

2009-09-06T06:40:00.000-07:00

Robert Baker MD Health Newsletter
http://RobertBakerMDHealthNewsletter.blogspot.com

Getting Vitamin D Results
This link contains an audiotape that can be listened to rather than reading.
http://GettingVitaminDResults.blogspot.com

Twitter:
Various facts on Vitamin D
http://www.twitter.com/RobertBakerMD

Links to Research on Vitamin D
http://www.twitter.com/VitaminDWebSite

Other health information can be obtained by clicking on "View My Complete Profile" on the left hand side of this blogspot

3. TREATMENT OF HYPERTENSION

2009-09-01T12:00:00.000-07:00

MEDICAL TREATMENT OF HYPERTENSION

Hypertension is present in 20% of all Americans and is even higher in those over 50. Control of hypertension has been proven to be effective in preventing heart attacks, heart failure, and strokes. Virtually all prescription drugs have side effects, and some of the common ones are mentioned, but obviously someone taking medication for hypertension should not make changes or stop a medication without discussing it with his or her physician.

Diuretics are first-line therapy for many, and include hydrochlorthiazide (HCT), and Hygroton. Stronger “loop” diuretics are Lasix and Edecrin. Side effects include lowering the potassium levels, muscle cramps of the leg, and frequent urination leading to interrupted sleep. Potassium-sparing diuretics include Dyazide, Amiloride, and Aldactone. Many people end up needing to taking prescription potassium, 800 mg.(20 mEq)a day, but this can frequently be avoided by getting the potassium in the diet. It is well known that a banana contains potassium (10 mEq), but it is less well known that a baked potato contains 15 mEq of potassium. Diuretics are frequently used in combination with other types of hypertension drugs.

ACE inhibitors (angiotensin converting enzyme) are also often used as first-line. It has been shown to be particularly protective of the kidneys and heart when impairment is present. They are even recommended for diabetics who don’t have hypertension but have protein in the urine (a very early sign of kidney disease). Examples are Lisinopril, Lotensin, and Capoten. An occasional side effect is hives.

ARB’s (angiotensin receptor blockers) are equally protective for the heart and kidneys. Examples are Cozaar,Benicar,and Diovan.

Beta blockers counteract adrenaline, and are excellent for people who have other indications for them, such as migraine, angina, heart attack, heart failure, and even stage fright. It is less often used initially. Examples are Inderal, Atenolol, and Lopressor. They slow the heart rate, which often is a desirable effect.

Calcium-channel blockers (Cardizem, Verapamil, Calan, Norvasc) and direct vasodilators (Hydralazine and Minoxidil) work by dilating arteries. Some of these can cause annoying swelling (edema) of the legs.

Central alpha-adrenergic agonists (Catapres) decrease the activity of the nerves that interact with adrenalin. They are very effective used with other drugs for severe hypertension, but frequently cause fatigue that may limit their use.
An important principle in dealing with your hypertension is “don’t give up.” The majority of people with hypertension need more than one drug for good control. If a diuretic is used initially, an ACE inhibitor or ARB can be added for better control, and vice versa.

I have seen over the years instances of people who don’t take their blood pressure medicines because of the expense. Most diuretics,some ACE inhibitors and beta blockers are inexpensive. ARB’s tend to be expensive. Many times doctors may not know the cost of some of the medications they are prescribing. The pharmacies of Walmart, Target,and Shop Rite have lists of generic drugs for less than $4 a month, which is often less than insurance copays. Generics are regulated by the FDA and there hasn’t been a problem with generic anti-hypertensive drugs in decades. There are drugs from each class of anti-hypertensives with the exception of ARB’s on these lists. Don’t hesitate to discuss with your physician the use of these lists. $12 a month will enable most patients to take even 3 medications for hypertension, if that’s what’s necessary. Many drug stores enable you to get a blood pressure reading free of charge, so it’s easy to keep track of your blood pressure between office visits.
The message to remember is that good control of hypertension does work and does prevent serious,even catastrophic,illnesses.

THE NON-DRUG TREATMENT OF HYPERTENSION

In my second year of medical school, a cardiologist stated on our initial lecture on hypertension that once a patient has a high blood pressure reading, he or she always has to be on an anti-hypertensive drug for life. It is now known that the statement was totally false. Although the inaccuracy of this blanket statement is known by a growing number of Americans, the effectiveness of the non-drug treatment of hypertension is under publicized to the public, and as a result, underused.

Weight reduction: Not everyone with hypertension is overweight, but it is a major risk factor in hypertension. In those that are, weight reduction can lower blood pressure. The percentage drop in weight necessary to see a difference varies frequently from 10 to 30%.

A “2 gram sodium restricted diet” has been standard suggestions to those with hypertension for years. In the 1950’s, when only a few anti-hypertensive drugs were available, the “Duke University” diet used a brown rice and fruit diet and frequently dramatically lowered the blood pressure. A common response to telling a patient that salt restriction may help their hypertension is “I don’t add any salt to my food.” Studies have shown that the usual American diet can still contain over 5 grams of sodium without using any table salt. Now that food products are labeled, reading labels for the first time for sodium content can be quite shocking. Soups frequently contain 700 mg. of sodium per serving, and many people eat two servings at a meal. Fast food outlets frequently have sodium information available on the internet, but how many people actually take the time to research this information? Most people know that fast food french fries are salty, but how many know that fast food hamburgers frequently contain as much sodium as a serving of French fries.

A study published in September, 2009 in the American Journal of Health Promotion estimated the effect that a reduction of sodium to 2300 mg./day in the United States. Hypertension cases was predicted to be reduced by 11 million cases, saving in health care costs would total $18 billion, and 312,000 quality of life years would be gained, worth $32 billion annually.

Vitamin D insufficiency has been shown to adversely effect enzymes related to the control of blood pressure, and some studies have shown that correcting the insufficiency can improve blood pressure. Remember, at least 70% of Americans have vitamin D insufficiency, and over 95% have levels that are less than ideal.

Calcium supplementation has been reported to have a minor effect on lowering blood pressure. The calcium data is questionable, as the same dairy industry that has been accused of sponsoring deliberately misleading studies is behind much of the calcium data. Societies with very low calcium intakes but don't have rich diets have less, not more, hypertension.

Magnesium supplementation has been shown to have a definite but small effect in lowering mild hypertension. In the October 2009 issue of American Journal of Hypertension a study gave 600 mg. of magneisum daily, and the systolic and diastolic blood pressure readings dropped a few points over 12 weeks compared to placebo.

Low animal protein diets, such as vegan or vegetarian diets, frequently lower blood pressure independent of the weight of the individual.

Exercise and relaxation have an independent effect on lowering blood pressure.

Lack of sleep, especially chronic, has been shown to have a deliterious effect on blood pressure.

Pain can acutely or chronically raise blood pressure. Severe dental pain and chronic back pain in particular has been shown to have an effect on blood pressure, but the effect can probably be found in pain of all kinds.

Alcohol has a very variable effect. Many alcoholics have normal blood pressure. But in a definite percentage of drinkers, alcohol can have a major effect on raising blood pressure, with rapid improvement with cessation of drinking.

Caffeine can raise blood pressure acutely and long term, although the coffee lobby has tried to suppress this information with misleading publicity.

Eating whole grains can lower blood pressure. In the September, 2009 American Journal of Clinical Nutrition a study showed that men who eat the top 20% of whole grains have 19% less hypertension than those that ate the bottom 20%. Other studies have shown a similar effect in women.

Avoiding high sugar foods can lower blood pressure in some people. Eating high sugar foods cause the heart rate to increase in some, but not all, people, with pulse rates increasing as much as 20 beats per minute for as much as a few hours. Along with this, the blood pressure can go up. Specifically a study was presented at the American Heart Association Hypertension Research Conference September, 2009. 74 men were given an extra 50 Calories a day of fructose for just 2 weeks. The systolic blood pressure increased by 6 mm., the diastolic blood pressure increased by 3 mm.

Patients especially who suffer from many side effects of anti-hypertensive drugs such as fatigue or erectile dysfunction can benefit from modifying the many factors in the non-drug treatment of hypertension. The information is not new; a classic article “Non-Drug Treatment of Hypertension” by Norman M. Kaplan, M.D., was published in the Annals of Internal Medicine in March, 1985.

Revised 10/18/09

2. UPDATE ON VITAMIN D - 2009

2009-06-01T18:15:00.000-07:00

Why our daughters need their D level checked: It’s been know for decades that vitamin D deficiency weakens muscles. A study in the Dec, 2008. issue of Journal of Clinical Endocrinology & Metabolism reports its association with Cesarean delivery. Vitamin D levels were measured in 253 mothers. The rate of C-section was 14% for levels over 15 ng., and 28% for levels less than 15 ng. Normal is 32 to 100 ng). Many pregnant women would benefit if physicians ordered D levels for all their pregnant patients and treated to at least a level of 32 ng.

As for yourself - Vitamin D receptors are present in the brain. A recent study in the Journal of Geriatric Psychology and Neurology studied 2000 people over 65. Those with the lowest Vitamin D levels were more than twice as likely to have cognitive problems (an early sign of Alzheimers disease) than those with the highest. This shows that D deficiency may be an important not previously recognized link to Alzheimers.

And for infants- Autism is an epidemic that didn’t exist when we were born. It is a complex disease with various factors, as yet not fully understood, contributing to its origins. Studies have shown a higher incidence of autism in women who were pregnant during the winter when Vitamin D levels are lowest. Other studies have shown higher autism rates within the same state in counties that have more rainfall (and therefore less sunshine). Autism is higher in African Americans (who have levels 10 to 15 ng. lower because less sunlight is absorbed through darker skin). The New York Times in March, 2009, reported a surge of autism in Minneapolis among Somalian immigrants. Sweden is now reporting a rate of autism among Somalians at 3 times the rate of non-Somalians.. This is just some of the growing evidence that vitamin D deficiency is an important factor in autism. It will take decades to prove it, studies are only being talked about at this point, and the theory is relatively new. Some case reports have shown some improvements with correction of vitamin D insufficiency, but no large studies have been done. The tests done for an autistic child are quite extensive but routinely don’t include a 25-hydroxyvitamin D level. The Vitamin D Council is recommending that every such child should be tested; and any insufficiency should be treated by their physician. For this and many other reasons, 25-hydroxyvitamin D levels should be a routine pre-natal test. Any pregnant woman should be proactive and insist her obstetrician get the test.

The missing link- Why didn’t we hear of vitamin D deficiency 30 years ago? A March, 2009 study in Archives of Internal Medicine did a vitamin D level on about 15,000 blood samples that had been stored from both 1990 (average 30 ng.) and 2003 (average 24 ng.) The drop was 20%, and only 25% of 2003 levels were normal. Less sunlight exposure is felt to be the main explanation. This largely explains the increasing incidence of osteoporosis and other conditions associated with vitamin D deficiency.

Is Vitamin D a “secret?” Major publications have written about vitamin D in the past few years. In September,2006, Reader’s Digest published an article entitled:”The Miracle Vitamin: New evidence shows that getting enough D may be the most important thing you can do for you health.” In February, 2008, Parade Magazine listed vitamin D levels as one of “5 Medical Tests That May Keep You Well;” In the same month, Jane Brodie of the New York Times wrote “An Oldie Vies for Nutrient of the Decade.” Suggestions have even been made by prominent experts that the Surgeon General issue a report on Vitamin D because of the beneficial effect public awareness would have on decreasing health care costs and improving public health. I believe that the realization of the pandemic of vitamin D deficiency is the most important medical discovery in at least 40 years.

A guiding principle with taking Vitamin D

For those who like to keep things simple as more information becomes discovered about Vitamin D, the following should be remembered. If preventing osteoporosis was the ONLY thing that Vitamin D did,that would be enough reason to treat Vitamin D levels to at least 40 nanograms, and probably 50 nanograms.

Vitamin D and Cancer
One of Vitamin D's main actions is to prevent hyperproliferation of cells. That term describes what happens with cancer. There are substantial studies over the past several decades that show that low 25-hydroxyvitamin D levels vary inversely with the incidence of breast, prostate, and colon cancer. In a well publicized large study published in 2007, the lower the level, the more agressive the breast cancer. Prostate cancer studies have shown that vitamin D lowers the PSA level, an important tumor marker, and has effective anti-tumor action against prostate cancer.

Other cancers:
There are also many studies showing that vitamin D has activity in actually treating established cancer, especially breast and prostate cancer. Fewer studies have been done with less common cancers.

Thyroid cancer: There are in vitro and animal studies showing that thyroid cancer cells are significantly slowed down in their multiplication with Vitamin D. Thyroid nodules (which are a pre-cancerous lesion) are very common in hyperparathyroidism, and this condition is almost always associated with a low 25-hydroxyvitamin D level, which overstimulates the parathyroid glands.

Pancreatic cancer: Studies show that the incidence of pancreatic cancer is twice as common with low vitamin D levels.

Lung Cancer: Studies show a strong correlation of lung cancer with vitamin D levels, and substantial evidence that vitamin D has an chemotherapeutic effect when used in established cancer.

Vitamin D and the interaction of other risk factors
Many cancers have identified risk factors. Thyroid cancer is strongly associated with radiation to the neck as a child. Breast, prostate,and colon cancer have a number of proven risk factors. It has been well known and proven since 1965 that cigarette smoking causes lung cancer, and it is less well known that cigarette smoking is a strong risk factor of pancreatic cancer. A low vitamin D level works in conjunction with other risk factors. It is a non-specific stimulus to hyperproliferation of abnormal cells, and if these cells are damaged by other risk factors, it is a lot easier for cancer to develop. 25-hydroxyvitamin D levels, along with genetic factors, may be a large part of the explanation of why some smokers never get lung cancer. The same could be said of other cancers with their own risk factors.

What does this means in real terms? In an estimate so shocking it's hard for many to believe; according to leading Vitamin D experts and based on research studies that have been done, if every woman had a 25-hydroxyvitamin D level of 32 nanograms (the lowest level considered as normal, although it's far below the ideal level), the incidence of breast cancer would be cut 50%. The same probably can be said with men and women for colon, and men for prostate cancer. The same is also likely true for other cancers, but research has not been done yet.

Vitamin D and hereditary cancer genes - a theory
There are no studies that can be found regarding the BrCa1 gene, BrCa2 gene, and other heredity cancer symdromes and 25-hydroxyvitamin D levels. The BrCa1 gene has one of the most profound effects on it's carriers of all known hereditary cancer genes. Not all of it's female carriers get breast cancer, (it's frequently in the 30's when carriers that do get breast cancer become diagnosed, although just about all get ovarian cancer by the age of 58 if the ovaries aren't removed.) Would agressively treating 25-hydroxyvitamin D levels preferably to over 50 nanograms reduce the incidence of breast cancer in BrCa1 gene carriers? This is unknown, but could be an easy study to do, given the large amount of BrCa1 female carriers who follow the path of mammograms and MRIs of the breasts starting in their 30's. Unfortunately, I don't think this study is imminent. Carriers shouldn't wait; they should treat their vitamin D insufficiency to ideal levels.

1. UNDERSTANDING YOUR CHOLESTEROL NUMBERS

2009-03-01T00:59:00.000-08:00

Cholesterol is made up of LDL and HDL. LDL cholesterol (the “bad cholesterol”) is deposited onto the walls of arteries, causing inflammation and atherosclerosis, and the end result is a heart attack or blockages in arteries of the neck or leg. HDL cholesterol (the” good cholesterol”) takes cholesterol away from the artery walls. Total cholesterol numbers can be misleading at times. If someone has an unusually high HDL cholesterol, that’s good, but it raises the total cholesterol. A high HDL can be due to genetics and can be raised by exercise. For those of you interested in formulas, total cholesterol = LDL + HDL + triglycerides/5 (but this is not valid if the triglyceride is over 300 mg.).
Normal cholesterol has changed over the years as more research was done. In 1974, normal was up to 250 mg. In the 1990’s, normal was reduced to a maximum of 200 mg. Normal LDL is below 100 mg. Normal HDL cholesterol is 40 mg. or greater. A few years ago research showed that for someone who has already had an illness caused by atheroslerosis, such as a heart attack, or if someone has diabetes, there is further benefit in getting the LDL below 75 mg. The ratio of LDL to HDL, once thought to be important, is not emphasized now. The reversal of atherosclerosis, which was proven by studies in the 1990’s to be possible, requires very low cholesterol; preferably an LDL below 100 mg.
Cholesterol, first discovered in 1910 to be the primary substance that makes up atherosclerosis, and modified by many factors from the genes we are born with to the food that we eat, remains the most important of many risk factors for atherosclerosis.

SUPPLEMENTAL INFORMATION
NORMAL (IDEAL LEVELS)
Total Cholesterol ..... < 200 mg.
LDL Cholesterol ..... < 100 mg.
..... 100 to 130 mg. is considered borderline
LDL Cholesterol if a heart attack or other atherosclerosis event has taken place < 75 mg.
LDL Cholesterol in diabetics ..... < 75 mg.
HDL Cholesterol ...... > 40 mg.
Triglycerides ...... < 150 mg.
Excess weight, dietary cholesterol, dietary fat, and poorly controlled diabetes raise LDL cholesterol. Although much has been made about polyunsatured fats vs. saturated fats since the 1970’s, studies have shown a minimum drop in switching from saturated fats to polyunsaturated fats. Polyunsaturated fats and cancer promotion is a whole different issue. Genetics strongly interact with the above factors; some obese people have low cholesterol, some thin people have high cholesterol.
Exercise and genetics raise HDL cholesterol to better levels. HDL frequently varies inversely with triglycerides.
Triglycerides are very responsive to weight gain or loss and diabetes control. An obese person can frequently get large drops in triglycerides with only a 10% weight loss.
Blood samples should be obtained after an overnight fast. Non-fasting samples can raise cholesterol a few mg. but can raise triglycerides a great deal.

OTHER RISK FACTORS

Elevated blood pressure, blood sugar (diabetes), levels of homocysteine (associated with insufficient levels of vitamin B12 or folic acid), high insulin levels (usually found in obese individuals), and vitamin D insufficiency can accelerate atherosclerosis. Elevated C-reactive protein is an indication of inflammation within the coronary arteries; levels can be lowered by the same measures used to lower LDL cholesterol.

HOW IMPORTANT ARE THE RISK FACTORS?

The notion that 50% of people suffering a heart attack have normal cholesterol levels has been spread usually by people who are selling information or products that require the minimizing of the importance of cholesterol. The way this is done is that these people take a high number, 225 mg. or 250 mg. as a "normal" cholesterol, or a high number of LDL cholesterol as "normal". This notion has been clearly disproved, but unfortunately will live on.

The truth has been shown by a study all the way back in 2003! in the Journal of the American Medical Association . A study looked at 3 comprehensive studies and concluded that 90% of coronary heart disease (CHD) had a history of elevated cholesterol, hypertension, cigarette use, or diabetes. In 2005 an Annals of Internal Medicine study showed that 8% of CHD events will actually occur with only borderline abnormal levels of multiple risk factors.