Vitamin D, what it is, how do I get it & what does it do?

According to a 2012 study, nearly 50% of the worldwide population is deficient in “Vitamin D” ( 25-hydroxy-Vitamin D or calcidiol), which is technically not a vitamin at all, but is a “pre-hormone”, a biologically inactive glandular secretory product, having little or no biologic activity, that is converted to an active hormone.

Vitamin D is produced in the skin through direct UV light from the sun. Through complex enzymatic processes, it is converted into its usable form.

So why are so many people deficient in it? The authors of that 2012 study attributed deficiency to lifestyle -ie reduced outdoor activities- and environmental effects that reduce exposure to sunlight (like air pollution). Access is another limiting factor, those living north of the latitude of Boston,MA (~40 N) don’t get enough UV light exposure from the sun for vitamin D synthesis through the months of November to early March.

So how else can you get Vitamin D? It can also be consumed in the diet, although very few foods naturally contain vitamin D- fatty fish (mackerel, salmon, sardines), fish liver oils, and eggs from hens that have been fed vitamin D or milk that has been fortified with it. Or, you can supplement with it.

Once consumed or synthesized, vitamin D enters the circulation and is transported to the liver where it is converted to form 25-hydroxyvitamin D (calcidiol; 25-hydroxyvitamin D). This is the major circulating form of vitamin D and a useful indicator of vitamin D nutritional status. This is the form of Vitamin D that is tested in blood tests.

Once active Vitamin D is in our systems, it plays many valuable roles (see Clinical Benefits below) and deficiency can result in a host of symptoms, including muscle weakness and pain, fatigue, painful menses, bone malformation, osteoporosis, chronic illness, diabetes, hypertension, autoimmune diseases and cancer.

To find out if you have adequate Vitamin D levels, make an appointment to come in today. Too often the vague symptoms of Vitamin D deficiency go ignored.

From Nair & Maseeh’s 2012 article in the Journal of Pharmacology & Pharmacotherapeutics

Clinical Benefits of Vitamin D:

Cancer: Vitamin D decreases cell proliferation and increases cell differentiation, stops the growth of new blood vessels, and has significant anti-inflammatory effects. While it may be too soon to say Vitamin D alone is a cancer fighter, we do know it has a role in preventing cell changes that too often contribute to cancer development.

Heart disease & Type 2 diabetes: there is growing evidence that the protective effect of vitamin D on the heart could be via the renin–angiotensin hormone system, through the suppression of inflammation, or directly on the cells of the heart and blood-vessel walls, playing a role in preventing heart disease, hypertension and blood pressure & insulin regulation.

Obesity Low concentrations of circulating vitamin D are common with obesity and may represent a potential mechanism explaining the elevated risk of certain cancers and cardiovascular outcomes.

Depression A Norwegian trial of overweight subjects showed that those receiving a high dose of vitamin D had a significant improvement in depressive symptom scale scores after 1 year versus those receiving placebo.

Cognitive impairment Low levels of 25(OH)D may be especially harmful to executive functions. In an Italian population-based study, low levels of vitamin D were associated with substantial cognitive decline in the elderly population studied during a 6-year period.

Parkinson’s disease Parkinson’s disease is a major cause of disability in the elderly population. Unfortunately, risk factors for this disease are relatively unknown. Recently, it has been suggested that chronically inadequate vitamin D intake may play a significant role in the pathogenesis of Parkinson’s disease.

Fractures and falls Vitamin D is known to help the body absorb calcium, and many studies have shown an association between low vitamin D concentrations and an increased risk of fractures and falls in older adults.Supplementation with about 800 IU of vitamin D per day reduced hip and nonspinal fractures by about 20%. USDA Human Nutrition Research Center on Aging at Tufts University have examined the best trials of vitamin D versus placebo for falls. Their conclusion is that “fall risk reduction begins at 700 IU and increases progressively with higher doses”

Autoimmune diseases deficiency can contribute to autoimmune diseases such as multiple sclerosis (MS), type 1 diabetes, rheumatoid arthritis, and autoimmune thyroid disease.

Influenza  in the winter months vitamin D deficiency may be the seasonal stimulus that triggers influenza outbreaks in the winter

Pelvic floor disorders The frequency of Pelvic floor disorders, including urinary and fecal incontinence, is increasing with age. Pelvic floor disorders have been linked to osteoporosis and low BMD and remain one of the most common reasons for gynaecologic surgery, with a failure rate of 30%. Subnormal levels of 25(OH)D are common among women, and lower levels are associated with a higher likelihood of pelvic floor disorders.

Age-related macular regeneration High vitamin D blood levels appear to be associated with a decreased risk for the development of early age-related macular degeneration (AMD) among women younger than 75 years

Schedule Today to have your Vitamin D levels checked today:

503-287-4970

References:

Nair, R., Maseeh,A. “Vitamin D: The “sunshine” vitamin”. J Pharmacol Pharmacother. 2012 Apr-Jun; 3(2): 118–126.

OSU. Linus Pauling Institute. Micronutrient Center: Vitamin D

 

 

Vitamin D

Vitamin D Debacle
We have heard a lot of questions this week concerning the recently released Institute of Medicine’s (IOM) ‘new and improved’ recommendations for vitamin D and calcium intake.  While the Institute’s recommendations about calcium seem to be agreed upon by most, the recommendations released for vitamin D have caused quite a stir in groups of health care providers across the country.
To begin with, let’s review what Vitamin D does for us.  Whether through dietary intake or good old sunshine, once active Vitamin D has gotten into our systems, it plays a very valuable role.  Our immune system is greatly influenced by D, to the tune of increased and enhanced immune cell function. Vitamin D also assists with the very intricate regulation of calcium in the body— so without it, calcium cannot be absorbed nor integrated into our bones, therefore decreasing the integrity of our skeletal system (which, as it turns out, is actually pretty important to us).   The uncontrolled dividing of cells (AKA: rapid proliferation) and lack of cellular differentiation, which leads to the formation of cancers in the body, can be halted by the active form of Vitamin D.  It also plays a role in blood pressure regulation and insulin secretion as well as a host of other functions.  (To find out more, read a little here: http://lpi.oregonstate.edu/infocenter/vitamins/vitaminD/)
The actual IOM report is quite a tome, weighing in at total of 990 pages long.  (If you have a free weekend, take a gander for yourself: http://books.nap.edu/openbook.php?record_id=13050)  To be honest, I did NOT comb through all 1000 of the research articles that the IOM used in its decision making process.  Here are the basics: They have raised the suggested daily intake from 400 to 600 IUs of Vitamin D.
The other half of the research is focused on the suggested calcium supplement intakes (Not taking into account food-based calcium, how you prepare that food and what types of foods….).  At the end of it all, the researchers are saying that the recommended intake is 600 IUs (800 in the elderly, 400 in wee ones), but the upper tolerable limit, where “the risk of harm increases,” is 4,000 IU per day.  I feel that the intake recommendations are overly conservative, and quite limiting in light of the potential benefits that Vitamin D can offer.
The IOM is also recommending that threshold for Vitamin D testing be at the 20 ng/ml level. We generally like to see the levels around 80 ng/mls, but most people in the Northwest clock in around 20-30 on an initial screen.  Many of the studies quoted and used to formulate the new recommendations are based in toxicity studies.   It looks like the toxicity studies that they used for adults all included doses of Vit D of 100,000 to 150,000 IUs of Vitamin D a day for anywhere from 3-4 weeks to several years years….increasing the blood levels up anywhere from 150 to the 1000’s.  This is way too high! Other studies used are based off of cases of accidental over-fortification, which is very different than the supplemental Vitamin D that our patients have come to know and love.   Overall, not the most convincing body of evidence to base new lab levels on.
The best rebuttal to the statements made in the research came from the Vitamin D Council.  Here is that link:
http://www.vitamindcouncil.org/vdc-statement-fnb-vitamin-d-report.shtml
It is fairly humorous and mildly thick with disgust for claimed data mis-interpretation and deletion that is in the IOM statement.  Here are the salient response jabs:
–“After 13 year of silence, the quasi governmental agency, the Institute of Medicine’s (IOM) Food and Nutrition Board (FNB), today recommended that a three-pound premature infant take virtually the same amount of Vitamin D as a 300 pound pregnant woman.”
–“As a single, 30 minute dose of summer sunshine gives adults more than 10,000 IU (250 micrograms), the FNB is apparently also warning that natural Vitamin D input — as occurred from the sun before the widespread use of sunscreen — is dangerous. That is, the FNB is implying that God does not know what she is doing.”
–“Today, the FNB has failed millions of pregnant women whose as yet unborn babies will pay the price. Let us hope the FNB will comply with the spirit of “transparency” by quickly responding to our Freedom of Information requests.”
Another great article was on the Huffington Post by Dr. David Katz, whose work I generally enjoy and his articles seem to have a good enough natural-based-bent to them.
http://www.huffingtonpost.com/david-katz-md/vitamind–andcalcium-shouldwe–becautious_b_789842.html
His summary is as follows:
“Calcium and vitamin D are important nutrients. As with all nutrients, enough is good — too little or too much is bad. The IOM invokes the precautionary principle to offer recommendations that are reasonable, and willfully conservative. But a relative absence of evidence means that guidance is as much about judgment as science.”
I think at the end of it all, what I am falling back on is that checking patients’ blood levels, like any therapy we initiate, is key.  Yes, 5,000 to 10,000 IUs of Vitamin D for YEARS and YEARS might be too much (again, not enough data to support or negate).
But keeping people on 1000 to 4000 daily as a maintenance dose (and, of course, using higher doses when clinically needed) while keeping blood levels in check, is JUST FINE.
Especially in Portland, where our 2 months of partial sun in 2010 has us all a little cranky and seasonally affected.

We often hear questions concerning the ‘new and improved’ recommendations for Vitamin D and Calcium intake (from the Institute of Medicine) .  While the Institute’s recommendations about Calcium seem to be agreed upon by most, the recommendations released for Vitamin D have caused quite a stir in groups of health care providers across the country.

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The actual IOM report is quite dense and a total of 990 pages long.  (If you have a free weekend, take a gander for yourself.)  To be honest, I did NOT comb through all 100 of the research articles that the IOM used to make its recommendations.  But here are the basic recommendations:

Raise the suggested daily intake from 400 to 600 IUs of Vitamin D. The other half of the research is focused on the suggested Calcium supplement intakes (Not taking into account food-based Calcium, how you prepare that food and what types of foods…).  At the end of it all, the researchers are saying that the recommended intake is 600 IUs (800 in the elderly, 400 in wee ones), but the upper tolerable limit, where “the risk of harm increases,” is 4,000 IU per day.  I feel that the intake recommendations are overly conservative, and quite limiting in light of the potential benefits that Vitamin D can offer.

The IOM is also recommending that threshold for Vitamin D testing be at the 20 ng/ml level. We generally like to see the levels around 80 ng/mls, but most people in the Northwest clock in around 20-30 on an initial screen.

Many of the studies quoted and used to formulate the new recommendations are based in toxicity studies.   It looks like the toxicity studies that they used for adults all included doses of Vit D of 100,000 to 150,000 IUs of Vitamin D a day for anywhere from 3-4 weeks to several years… increasing the blood levels to anywhere from 150 to the 1000’s.  This is way too high and clearly excessive supplementation!

Other studies used are based off of cases of accidental over-fortification, which is very different than the supplemental Vitamin D that our patients have come to know and love.

Another interesting article on the topic came from a Huffington Post contributor, from Dr. David Katz, whose work I generally enjoy and whose articles seem to have a natural-based-bent to them.

“Calcium and vitamin D are important nutrients. As with all nutrients, enough is good — too little or too much is bad. The IOM invokes the precautionary principle to offer recommendations that are reasonable, and willfully conservative. But a relative absence of evidence means that guidance is as much about judgment as science.”

I think at the end of it all, what I am falling back on is that checking patients’ blood levels, like any therapy we initiate, is key.

Clearly, 5,000 to 10,000 IUs of Vitamin D for extended periods of time (YEARS and YEARS) or in the presence of naturally high blood levels is likely too much (although, the data to support or negate has yet to be generated sufficiently).

However, across the upper latitudes (Oregon, Washington, Canada, Norway, Sweden, etc..) providers have found 1000 to 4000 IU daily as a maintenance dose (and, of course, using higher/lower doses when clinically indicated) does not result in unusually elevated blood levels.

The key, then is making sure that you are supplementing under the care of a provider who evaluates your Vitamin D blood levels as indicated and supports you in making informed decisions to optimize your health.

Getting your Vitamin D levels checked should be part of every person’s winter health regimen. If you haven’t been tested this year, call the clinic today at (503) 287-4970, or email info@naturecuresclinic.com for an appointment.

Image courtesy: SeanMcGrath

Cold and Flu Season 2010: Are you ready for the onslaught?

by Dr. Greg Eckel

Nature Cures Clinic physician

Well it’s that time of year again.  The marketing machine rolls on with the public health campaign that says the only protection you have against the deadly flu is to get your flu shot. We have been reporting on this since the avian flu scare of 2005 (see podcast here).  1108486420_dccf9d415d

We recently just produced a new flu vodcast/ podcast.  Dr. Nigh and I really try to have fun while (hopefully) giving you some sane (and entertaining) commentary on the current climate of information.

A few years ago, we were asked to write up what you can do for viral illness for the state of Oregon.  We wrote this while working with the Alliance Working for Antibiotic Resistance Education (AWARE), a group working towards educating the public and doctors about improper antibiotic prescriptions and how they lead to antibiotic resistant strains of bacteria.  There is pressure at doctor’s offices to do something when their patients are sick.  The doctors in general will write a prescription for antibiotics, even though the majority of cases are viral in nature.  This improper prescribing of antibiotics in turn leads to the creation of super bugs, that are resistant to antibiotics.  The current medical system has very little to offer patients with viral illnesses.

The Centers of Disease Control, in the name of public health, has their 1,2, 3 list of what to do to increase your odds of not getting the flu this year:
1) Get a flu shot.
2) Stay away from those that are sick, wash your hands often.
3) Take anti-virals if you get the flu.

As far as public policy, this is lacking considerably.  Here I will once again reference our position paper linked above as another view of what you can do to increase your immune system’s vitality.

Let’s look at the research.  The conservative group the Cochrane Review, a consortium of scientists around the globe has done a great job in collecting the data on the effectiveness of the flu vaccine.  If we were to believe the propaganda machine of the mainstream media, you’d experience a 100% effective rate against getting the flu.  It is repeated by most of the medical societies so much so it must be true.  On review of the literature, we find, “Authors’ conclusions influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission.
WARNING:
This review includes 15 out of 36 trials funded by industry (four had no funding declaration). An earlier systematic review of 274 influenza vaccine studies published up to 2007 found industry funded studies were published in more prestigious journals and cited more than other studies independently from methodological quality and size. Studies funded from public sources were significantly less likely to report conclusions favorable to the vaccines. The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies. The content and conclusions of this review should be interpreted in light of this finding.”

Last year during the swine flu (H1N1) hysteria, I got into several debates with conventional doctors, who continually referred to websites of their professional organizations, saying they were supporting the flu vaccine.  I kept asking for the research to support their conclusions. In reality, the data is very slim and suspect, as the Cochrane review suggests.

The second recommendation is actually not bad; washing your hands often is a very good hygienic practice.  I like to have our patients focus more on their own terrain, rather than being paranoid of others’ illnesses.  But I do agree with the CDC recommendation number 2.

Let’s look at the third recommendation.  Take anti-virals if you get sick.  This seems to be more of a sanctioned ad for the pharmaceutical industry.  The research shows these anti-virals produce at best one day less of illness.  This is hardly enough for a national public health policy.  (Here is the citation that goes with this information: Antiviral medications are adjunctive agents for the prevention of influenza. They also are used early in the course of uncomplicated influenza infection to reduce the duration of illness by approximately 1 day. 12 12. Gubareva LV, Kaiser L, Hayden FG. Influenza virus neuraminidase inhibitors. Lancet. 2000;355:827-835. )

We have talked a lot through the years about the issue of terrain versus the bug.  Unfortunately, Louis Pasteur won the debate on germ theory and we are currently stuck with the outlook that the bug is the issue.  His contemporary at the time was Beauchamp, who argues that we are all exposed to the bug, why do only some of us get sick.  His point was that is the terrain that matters.

In practice of course it is both of these theories.  Our public policy only views the bug, holistically we consider both of them.  In recent times there is more and more research to support Vitamin D’s usefulness for immune system response.  We encourage all of our patients to have their vitamin D level checked at least once per year.  This gives you an opportunity to make sure you are in the ideal range for vitamin D’s effectiveness.

If you are interested in optimizing your immune system this cold and flu season, please call the office and schedule an appointment.  For more information be sure to watch or listen to our current vod/podcast here.

Here’s to a healthy and happy fall!

In health and sanity,  Dr. Eckel

photo courtesy: Trumanlo

Winter Health Tips

It’s been just about a year since a major winter storm hit the Northwest. While we’re crossing our fingers that we won’t be tromping through a foot and a half of snow this holiday season, it’s better to be prepared for the worst. You can stave off a number of weather-related illnesses and conditions with a bit of prevention.

Your overall health is our utmost concern, and as always, we recommend taking steps throughout the season to boost your immunity to colds, flu, and other seasonal disorders. Our articles on the importance of vitamin D and naturopathic prevention of swine flu are a good place to start.

On top of that, there are many things you can do to foster a healthy home environment. Continue reading “Winter Health Tips”

Naturopathic Prevention of Swine Flu

The mainstream media and most conventional physicians would have you believe that the only way to prevent swine flu is by getting a shot. Nonsense! Healthy immune systems have been protecting people from infectious diseases for many thousands of years. Our immune systems didn’t lose this ability in the last few decades, but the key is to have a healthy immune system. Continue reading “Naturopathic Prevention of Swine Flu”

Vitamin D – We Can’t Say It Enough

We’ve told you before how sufficient levels of Vitamin D can help reduce your risk of many chronic diseases, including cancer, heart disease, depression and diabetes.

While these are all very serious conditions that deserve your attention, there’s another ailment that’s dominating the headlines right now. You’ve heard it blasted in big letters — the FLU. And guess what? Study after study is showing that Vitamin D can help you battle that cold-weather illness too. Continue reading “Vitamin D – We Can’t Say It Enough”

Blood Analysis – How it can improve your health

Did you know that many symptoms may be the result of nutritional imbalances? When key nutrients become deficient, many metabolic processes are affected.

The body many initially try to compensate for such imbalances. However, if they are prolonged, they may contribute to hormonal issues, metabolic disorders, increase in toxic load, oxidative stress, organ weakness, etc.

The latest scientific research can help to identify a person’s nutritional needs and customize an effective regimen of nutrients. The cornerstone of an effective health strategy is a nutritional and lifestyle plan that is based on your biochemistry. What your body needs is revealed in your BLOOD TEST! Continue reading “Blood Analysis – How it can improve your health”

Kids, Health, and Vitamin D

If there were any easy way for tens of millions of people to reduce their risk of cancer, diabetes, heart disease, depression, osteoporosis and many other chronic diseases, shouldn’t that be in the headlines?

Researchers at the Albert Einstein College of Medicine discovered exactly that. In a large survey of the vitamin D status of children aged 1 to 21, they found that 7 out of 10 were deficient.

Did you know that if women maintain optimal vitamin D levels, their risk of breast cancer is cut in half? Did you know that maintaining optimal vitamin D levels also cuts the risk of colon cancer in half? In fact, getting this one single nutrient up to optimal levels would save untold lives and tens of billions of dollars annually in health care costs.

At Nature Cures Clinic we take this seriously. It’s why we test vitamin D levels on virtually every patient we see, and we make sure people get enough to get these protective effects. Continue reading “Kids, Health, and Vitamin D”

The Healing Power of Vitamin D

Listen to Vitamin D Podcast

Dr. Eckel and Dr. Nigh discuss what is arguably the most important nutrient that should be included in your diet.  They will tell you specifically where you can find vitamin D sources, and which form is the more active, and therefore the one you should be putting into your body.  From a naturopathic approach, Dr. Eckel and Dr. Nigh will tell you that they strongly disagree with what the government deems as an adequate vitamin D level for an individual.  How much should you be taking and how high should your blood level be? They’ll discuss these issues, as well as many more surrounding vitamin D, some that may even surprise you.

Hit Job

A recent study on antioxidants is a classic “hit job” on alternative medicine.

This study compared aspirin to a combination of antioxidants for their ability to prevent progression of arterial disease and diabetes. The study found that there was no difference in effectiveness between the two therapies. And without missing a beat, newspapers around the country proclaimed this new finding.

The dose of antioxidants used in this study is ridiculously low. For instance, this study used 100mg of vitamin C daily in their antioxidant supplement. While this is higher than the US RDA, it is somewhere between 1/5 and 1/20 the dose that is widely recognized to confer therapeutic benefits. Continue reading “Hit Job”

Vitamin D Levels and Metabolic Syndrome

Do we still need reasons to supplement with vitamin D? A recent study
published in the European Journal of Endocrinology found that subjects
with the highest blood vitamin D levels had an astounding 73% reduced
risk of metabolic syndrome. Metabolic syndrome is the name given to a
collection of signs and symptoms that together indicate an increased
risk of cardiovascular disease and diabetes. The syndrome includes
elevated blood sugar and triglycerides, abdominal obesity, high blood
pressure and low HDL (“good”) cholesterol.

Another study, just published in the Archives of Internal Medicine,
found that men with the lowest blood levels of vitamin D had *2.5 times
the risk* of a heart attack as men with the highest levels of vitamin D.

Oh, vitamin D, is there no disease you can’t protect against?

Vitamin D and Vascular Disease

Low levels of vitamin D have already been associated with everything from cancer to depression. A new study has found that low vitamin D levels lead to a significantly increased risk of peripheral vascular disease (PVD).

PVD covers a wide range of conditions, from atherosclerosis to embolisms. While only a small portion of individuals with PVD have been diagnosed, the complications of PVD include heart disease, stroke and many other serious medical problems.

It has already been shown that vitamin D could cut in half the risk of both colon and breast cancer. By adding PVD to the list, vitamin D alone has the potential to save millions of lives and billions of dollars each year in medical expenses.

The Most Important Vitamin?

We’ve written before about the increasing amount of research on vitamin D. There are few nutrients that can claim the health benefits of this single vitamin.A study recently published in the Archives of Internal Medicine adds even more weight to the importance of this vitamin. Low blood levels of vitamin D have been correlated with everything from depression and diabetes to osteoporosis and allergies.

When 18 studies involving over 57,000 people were analyzed, those individuals who took vitamin D supplements had a significantly lower mortality rate than those who did not take vitamin D. Continue reading “The Most Important Vitamin?”