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?
8/1/11
#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!
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!
5/17/11
#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%
#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%
5/14/11
#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.
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.
5/1/11
#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.
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.
4/5/11
#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.
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.
10/2/10
#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.
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.
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