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.
7/24/10
12) UPDATE ON MULTIPLE SCLEROSIS AND VITAMIN D
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.
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.
7/7/10
11) VITAMIN D, TELEMERS, LONGEVITY, CARDIOVASCULAR HEALTH, AND LOWERED CANCER INCIDENCE
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.
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.
7/5/10
10) OSTEOPOROSIS 2010
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.
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.
7/1/10
9) CASE HISTORY - COMPLETE REMISSION OF 16 YEARS OF PROGRESSIVE MS WITH VITAMIN D
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.
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.
6/1/10
8) ASTHMA
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.
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.
5/1/10
7) UPDATE ON VITAMIN D - 2010
(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.
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.
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