#34 VITAMIN D STUDY: VITAMIN D DOES PREVENT BROKEN BONES AND MANY ILLNESSES

    The recent vitamin D study that reviewed many vitamin D studies is making the claim that vitamin D doesn’t prevent illnesses.

    It looked at a large number of vitamin D studies on humans – most of them using a dose of 800 units maximal of vitamin D3.

    800 units doesn’t work.  Everyone can agree on that.  Studies have shown it raises the vitamin D level very minimally.  The most you can say is it’s very slightly better than nothing.  It can prevent rickets in children, but that’s about it.

    When an adult has a 25-hydroxyvitamin D level less than 32 ng. (48 nMol), depending on their weight, their body mass index, and their actual level, it is common that the dose they need is 5000 units of vitamin D3.  This will get the level  over 32 ng. in most people, although some people may need more as a temporary or maintenance dose.  Often a repeat level should be obtained at 6 months. 

    A massive amount of studies that have been done over the last few decades show that when vitamin D is given in a sufficient dose, broken bones can be avoided, osteoporosis can be improved, and many illnesses can be helped or prevented.   

      It is unfortunate that this study with the misleading conclusions has received so much publicity.  Vitamin D deficiency is a serious public health problem.  In view of this publicity, there is likely going to be tens of thousands of people who stop taking their vitamin d in spite of having a vitamin D insufficiency.  

       Some of these people are going to suffer, in fact die, from broken bones, and suffer from many other illnesses, because of this study.  I wish this was an exaggeration, but all the evidence suggests it is not. 

             

#33) Vitamin D Pills Are of Extreme Benefit in the high percentage of us that have insufficient levels -Baker Newsletter

 

       This is the type of headline that the public should see.  That is why I am posting it. 

       Because most of us don't live near the equator (where life on earth is believed to have started), we cover up most of our skin most of the time when outdoors, and because of other factors, a high percentage of humans have insufficient levels.  The evidence of this is MASSIVE and CONCLUSIVE.. Some of the evidence is posted on various entries to this Newsletter.  
       
       

#32) INDEX CASE OF IMPROVEMENT OF MYASTHENIA GRAVIS WITH VITAMIN D NOW VERIFIED WITH A FORMAL RESEARCH STUDY

On May 14, 2011, I posted #19) CASE HISTORY: SUBJECTIVE AND OBJECTIVE IMPROVEMENT IN MYASTHENIA GRAVIS FOLLOWING AGGRESSIVE TREATMENT OF VITAMIN D INSUFFICIENCY. I wrote about Debbie, a lady who was diagnosed with MG at age 41 in 2001. http://robertbakermdhealthnewsletter.blogspot.com/2011/05/case-history-subjective-and-objective.html

I first saw her in November, 2008 when she was on a high dose of prednisone for her disease, and also had vitamin D insufficiency diagnosed with a blood level. It made sense that MG should respond to vitamin D. It is a disease caused by production of abnormal antibodies that attack receptors located between muscles and nerves. I had previously searched MEDLINE and the internet using several search engines and was unable to find any research study or case history reporting on a connection. There simply were none. So I told Debbie we need to treat her vitamin D insufficiency to treat and improve her osteoporosis promoted by the steroids. I added that if there was a positive effect on her illnesses, that would be a bonus. I wrote up the response that Debbie had in the above mentioned Health Letter.

In mid-2012 I saw patient Sara who was 27 and had been diagnosed with myasthenia gravis the previous year,
confirmed by special tests. She had been advised by her neurologist to have her thymus gland removed, a procedure
that often helps relieve symptoms of myasthenia gravis. (It is felt that myasthenia gravis is caused by antibodies that are produced by the thymus gland, which is a gland in the neck related to the immune system.) She was holding off on the final decision.

At that time her 25-hydroxyvitamin D level was low. I discussed with her the treatment of vitamin D deficiency, the experience of my patient Debbie, and the possible beneficial effect it can have on myasthenia gravis. She started 5000 units of vitamin D with instructions for getting up follow up levels.

I saw Sara again about a year later. She had not had any surgery. Her symptoms were 80% improved. No change was made from a year before except the addition of 5000 units of vitamin D. She has given me her kind permission to use her first name in this write-up of her case.

Three months before seeing Sara a second time, a group of neurologists from Sweden published a study in the European Journal of Neurology (December 19, 2012). They studied 33 patients with MG. 13 patients were started on Vitamin D 800 units a day with a follow up an average of 6 months later. Neurologists use an objective test called the MGC
to measure the severity of fatigue with MG. (Fatigue is a prominent symptoms of MG). The MGC score in the 800 Unit vitamin D taking subjects improved 38%.

I emailed one of the authors and supplied to her the link of the case history report involving Debbie. She responded by telling me another doctor had shared with them a similar case also using 5000 units of vitamin D daily. She indicated that her group was planning further studies involving a dose close to what Debbie and this other case she heard about received.

The Swedish study was published in December. 2012. Up to that point no study had been published in a medical journal regarding the use of vitamin D to treat MG. The case report on Debbie that I published on my internet health letter represents the first case report ever published anywhere on the subject. My 2 case studies had far more than 38% improvement, but the dose I used was much higher than the 800 units used in Sweden.

My 2 case histories using 5000 units of vitamin D (and the Swedish study showing lesser improvement with 800 units) leads to the following recommendations that apply to every patient with MG:

1. Every MG patient should receive a 25-hydroxyvitamin D test (it will be low), and have the insufficiency treated, preferable to a level of 50 to 80 ng (125 to 200 nM.) (Treatment of vitamin D insufficiency is already recommended by vitamin D experts for the prevention of osteoporosis and other illnesses).

2. Other treatments for MG may need to be given as should be determined by the patient’s neurologist. However if the improvement is substantial enough, other treatments may not be necessary.

#31) INFLUENZA AND VITAMIN D - REVISITED

The start of an influenza epidemic has made the headlines and it appears it will be worse then recent years. News reports indicate that at least 25% of people getting the flu had this year’s influenza vaccination prior to the outbreak. Complicating the issue is that many reports focus on “flu like illnesses and assume that this is the flu. The only way a definite diagnosis can be made is a special throat or nasal culture which tends to be expensive, and is usually reserved for those who are sick
enough to be hospitalized. A clinical diagnosis is suggested by high fevers over 101 degrees, severe musle aches, and sore throat. Many people use the term flu very loosely in describing gastroenteritis symptoms only – nausea, vomiting, and diarrhea. Influenza is a serious issue. There have been deaths confirmed by cultures in the past month.

On September 12, 2010, I posted #14, Prevention of Influenza With Vitamin D. There was a very well performed study published in the May, 2010 issue of the American Journal of Clinical Nutrition. This study is still on the web and free for anyone to read. Simply google the name of the Journal. The test was very rigorous, and used nose/throat cultures to confirm the diagnosis of influenza A. The dose of the vitamin D given for 4 months before the winter was only 1200 Units. The study was double lind so there is no way any bias of the researchers would have changed the results.

The full details of the study can be read by going to #14 on this health letter. But in summary, there was a 41.9% reduction in the incidence of the flu. An unexpected result was that there was an 83% reduction of asthma attacks in those children who had a history of asthma. This makes sense since asthma is clearly a disease caused by antibodies and vitamin D has clearly been shown in studies to reduce the production of abnormal antibodies that cause disease.

So whereas just about everyone is scared of the flu and the serious illness and even sometimes death it can cause, but are you scared enough to have your doctor obtain a 25-hydroxy vitamin D blood test (covered by most health insurance), and spend $2 a month for 5000 units a day of Vitamin D3 which most people need with an occasional exception?

The news of the flu epidemic has been very well publicized through international newspapers, but there has been no mention of this study from October, 2010. I wrote in the column October, 2010, “Unfortunately we CANNOT rely on the press to keep us informed of critically important medical studies.”

#30) UPDATE ON VITAMIN D 2013

As you probably know by now, vitamin D primarily comes from the action of the sun on the skin. Just about everyone agrees that human life began near the equator. So vitamin D levels of early humans were very high. Modern studies show that 50 to 100 nanogram (ng) levels were common, and have been shown to have substantial benefit on human health. It is impossible to get enough vitamin D from diet. 4 glasses of cow’s milk contain 400 units, and most of it was added by the milk manufacturer. A
human being going with insufficient vitamin D is like an automobile being driven without oil. This comparison helps explain why vitamin D has a beneficial effect on so many conditions found in humans.

What has been known for over a century is the connection between vitamin D and bone strength. Vitamin D greatly increases the absorption of calcium from our diet, and that calcium helps maintain bone strength. Osteoporosis has been a household word for over 25 years, but the emphasis was put on calcium supplements, and vitamin D levels were not obtained. It was not appreciated that vitamin D insufficiency in Americans is widespread (80% are insufficient). Once the vitamin D level reaches at least 40 ng., calcium absorption from simple foods such as fruits and vegetables increases up to 90%. Studies have shown at this level the parathyroid glands in the neck stop producing excess parathyroid hormone. This hormone is the basic cause of the osteoporosis that is so prevalent and is the primary cause of broken bones as we age. The big medical mistake of 1985 to 2005 was the recommendation that humans need only 600 units of vitamin D daily, an amount far too little, and an amount that will not raise blood levels of vitamin D more than 4 ng. The effect on bones is by far the easiest beneficial effect to demonstrate. I have seen a number of people who have improved their DEXA scan by 15% within 2 years with 5000 units of vitamin D alone. Numerous studies show the same thing.

My update of 2011 lists 4 broad categories of diseases that benefit
from vitamin D. For each category, hundreds of studies prove the benefit. In the year 2012, each month has seen at least 5 major studies published in medical publications proving a beneficial effect on various illnesses. I have not seen even one newspaper article reporting these many studies. There was however one study that made the news. Someone studied the effect of 600 units of vitamin D on various illnesses and found no effect. The bizarre conclusion was that it’s not worth it to take vitamin D. The truth is that many studies had already shown the lack of beneficial effect from such a small dose.

You have also probably heard of the November 2010 study published by the impressive sounding Institute of Medicine that concluded we should take 600 units of vitamin D. They ignored most of the vitamin D studies that had been done over the past few decades and then claimed insufficient proof. They didn’t fool the scientists and physicians at the Harvard School of Public Health, who quickly published a complete refutation of their report. The original report made the front page of virtually every major newspaper; the response didn’t make any newspapers.

#29) LEARNING ABOUT VITAMIN D

Many people who access this web site do so in order to find out about vitamin D. They may have a specific illness that they have heard is connected to vitamin D deficiency, or they may have been told by their doctor that their vitamin D level is low. It takes time to scroll through all these entries, so this is a guide on how to find out about vitamin D in the most efficient way.

Entry #7: Update on Vitamin D – 2010.

This is a very concise summary of some of the major actions of vitamin D. This would be the FIRST thing to read. In fact, if you read only this, you will know quite a bit about vitamin D. In the last year there have been similar articles published in medical journals with documentation of dozens of references.

#15 and #23 : both give details regarding breast cancer.

#17 and #25: osteoporosis and documentation of improvement in bone strength with vitamin D.:

#9, #12, and #21: multiple sclerosis, including the details of a total remission. One of the best web sites on the subject is available at www.VitaminDMSCure.com. Anyone who is interested in MS should the several pages on this this web site.

#14: influenza

#24: rheumatoid arthritis

#19: myasthenia gravis

#28: scleroderma

Entry #2 and #18 give further updates with a list of some vitamin D related conditions.

#28) CASE HISTORY: MARKED IMPROVEMENT IN SCLERODERMA WITH TREATMENT OF VITAMIN D DEFICIENCY

(revised August 26, 2013) (revised November 14, 2013)

Kathy is a lady who was diagnosed with scleroderma in January, 2005 at the age of 45. Her initial illness was very serious; she was in acute renal failure as a result of it, and was on hemodialysis for months. She has been under the care of a rheumatologist and is on multiple medications including prednisone from early on. The first several years, in addition to her acute renal failure, she lost the fingers of her right hand, a characteristic manifestation of scleroderma. She also suffered from severe chronic fatigue.

Scleroderma is a rare disease and I have seen only a small number of patients with the condition during my career. However I know it is thought to be a disease caused by the production of abnormal antibodies. I also knew that studies had been done previously that showed that scleroderma is associated with very low vitamin D levels. This was not a surprise when I learned this, since scleroderma is a connective tissue diseases like rheumatoid arthritis, systemic lupus, and Sjogren’s syndrome also shown to be associated with very low vitamin D levels, lower than the general healthy population; and in some cases medical research studies showed an improvement of symptoms with these illnesses with the treatment of vitamin D deficiencies.

I first saw her as a patient in January, 2010. I told her it may be important to get a 25-hydroxyvitamin D level. The results showed a level of 15 nanograms (ng.), equivalent to 22.5 nMol., (a unit more commonly used in Great Britain).  I started her on 50,000 units of vitamin D2 a week, (an average of 7143 units a day). Vitamin D2 is a prescription drug in the United States.  An alternative dose of 5,000 units of Vitamin D3 daily can be used also ( a total of 35,000 units a week). Vitamin D3 is over the counter, and in the United States is extremely inexpensive ($2 a month in a prominent chain pharmacy).  In my practice of medicine, I have over 7,000 patients with vitamin D insufficiency or deficiency who are on this dose of vitamin D2 or D3.)

She continued to see her rheumatologist and primary care doctor. I saw her again on May 2, 2012. She told me that within a few months of starting the vitamin D, her years of fatigue improved and then resolved. Her kidney function before the vitamin D showed a creatinine of 1.4 mg.; a recent one was now 1.2 mg. In September, 2013, it improved significantly further to a level of 0.8 mg.  Her creatinine is now normal.  It has improved 42.8%.  (Serum creatinine is a very important measure of kidney function, and renal impairment  sometimes occurs with scleroderma).  Immediately prior to the vitamin D, her prednisone dose as prescribed by her rheumatologist, was 40 mg. a day. Once the vitamin D was started, because of an improvement in her overall symptoms, her doctor was able to slowly the dose to 5 mg. a day. (40 mg. of Prednisone a day for an extended period of time almost always causes major serious side effects; in comparison 5 mg. is associated with much less severe side effects). Since 2010, Kathy has had follow up levels of 25-hydroxyvitamin D and the level indicates a sufficient level.

On May 11, 2011, I posted: #19, a case history regarding myasthenia gravis (MG) and vitamin D.. and since then it's been updated. http://robertbakermdhealthnewsletter.blogspot.com/2013/06/35-index-case-of-improvement-of.html  This is the first case history ever reported of MG being treated and improving with vitamin D.  On July 1, 2010, I posed a case history of a complete remission of progressive multiple sclerosis with Vitamin D, a remission that is still complete as of June, 2013.. However in this case, there is a large volume of medical studies that have documented improvement of MS with Vitamin D. Many have been published AFTER my report of 2010, but many were published before. 

So is this case report of scleroderma more similar to a new finding in the case of MG, or just a demonstration of a previously discovered connection, as in the case of MS? To find out, I had to search the internet.

Vitamin D levels in scleroderma have been found to be remarkably low. There is direct correlation between the severity of the disease and levels of vitamin D. Especially important is that lung manifestations of scleroderma are more common and severe the lower the level. Fibrosis (scar tissue) which can be widespread in advanced scleroderma has been show to be inversely related to vitamin D concentration. The abnormal deposition of calcium deposits in the tissues (called metastatic calcification), found in the most severe cases of scleroderma, is related to high parathyroid levels and very low vitamin D levels om patients without scleroderma, and a study that looked at parathyroid levels found in fact that parathyroid levels in scleroderma was very high. As far as case reports, there are some, but not the “perfect” prospective double blind study.

There are various theories about some of the causes of scleroderma, not having anything to do with vitamin D.  But the theory based on substantial evidence with medical studies is that vitamin D prevents the production of abnormal antibodies caused by a wide variety of illnesses,

Most people reading this do not know anyone with scleroderma because fortunately it is a rare disease. But everyone knows someone with an autoimmune disease. Help them out, send this link to them.  

27) MYASTHENIA GRAVIS ASSOCIATION AND VITAMIN D

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

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?)

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

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%.

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

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

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

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

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 has kindly given me permission to use her first name. 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

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

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

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

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.