The Great Debate

Posted in Integrative Health.

Earl’s raspy breathing often preceded him on his visit to the doctor’s office.  “Darth Vadar!” the receptionist would kiddingly say as he opened the office door.  This, plus his shortness of breath, fatigue and depression sent him repeatedly to his family practitioner, cardiologist and pulmonary doctor.

When Earl came to see us at the Center for Integrative Health, he was ashen, gray and wheezing.  After an extensive interview, we put him on a regimen for his symptoms.  A week into his treatment he felt better but when his studies came back he was seen to have a severe Vitamin D deficiency and was immediately put on 5,000 IU daily of Vitamin D3.  

After one week, Earl’s wife called to report that not only had his wheezing stopped, the same receptionist didn’t recognize him and had to ask him his name because she  no longer heard  “Darth Vadar!” entering the suite.

Vitamin D or calciferol, actually a prohormone made from cholesterol, was until recently thought only to be involved in healthy bone production and maintenance.  However, newer research has shown it to be necessary for balance, muscle and tendon health, immunity and prevention of infection, heart disease and cancer. 

Most foods with the exception of fatty fish are poor sources of Vitamin D.  Fortified food such as milk, soy products and cereal grains are enriched with synthetic Vitamin D2, which has to be metabolized to the active form of the vitamin.  However, each quart of milk is fortified with only 100 IU of Vitamin D2 making the possibility of meeting the daily requirements from food intake highly unlikely.  Most Vitamin D comes from the action of sunlight on the cholesterol in the skin.  The sunlight’s ultraviolet B rays’ penetrating the skin, convert the cholesterol to the prohormone which is then transformed into the active form.  The amount of Vitamin D formed in the skin depends on the latitude, pigmentation, age and health of the individual.

At about the latitude of Delaware and all regions north of this state, it is highly unlikely that people will get enough sunlight to create an adequate amount of Vitamin D during the winter time. Research at Massachusetts General Hospital showed that 57% of the patients coming through the emergency room during the winter had Vitamin D insufficiency.  Dark skin individuals can especially suffer from lack of Vitamin D since they have a natural built-in “sunscreen” (melanin) that slows down the production of this vitamin.  A recent study in the American Journal of Pediatrics has shown that up to 42% of the African American teenagers may be deficient in Vitamin D because of pigmentation, diet and the latitude in which they live.  Another significant facet of   this problem is the increasing use of sunscreen and clothing to prevent skin cancer.  While these recommendations are advocated by physicians, there is some evidence that skin cancer may be related to Vitamin D deficiency rather than ultraviolet exposure and that there is little correlation with the deadly form of skin cancer, melanoma, with sun exposure.

In 2005, a meta study was released which demonstrated a beneficial correlation between Vitamin D intake and prevention of cancer.  This meta-analysis of 63 published reports showed that an intake of an additional 1,000 IU of Vitamin D daily reduced the risk of colon cancer by 50%, breast and ovarian cancer by 30%.  Further research has shown a beneficial effect of high levels of Vitamin D3 on patients with advanced prostate cancer.  In another study, Vitamin D supplementation with 1,100 IU daily in a randomized intervention following 1,200 women was seen to reduce by 60% the cancer incidence in a 4-year clinical trial.  If the cancers were excluded that originated in the first year, (which would have made them more likely to have been present   prior to intervention), the reduction soared to 77%.  In June of 2007 the Canadian Cancer Society recommended that all young, adult Canadians take 1,000 IU of Vitamin D in the fall and winter months.  Research also suggests that surgery for cancer patients done during the summer have a better survival than those during the winter when they are exposed to less sunlight.  Data from 4,000,000 cancer patients in 13 different countries showed a marked difference in cancers between countries classified as sunny and countries classified as less sunny for a number of different cancers.

Dr. John J. Cannell, a psychiatrist from San Francisco, treated patients in his ward with high doses of Vitamin D during a particularly virulent flu epidemic in 2005.  Over 10% of the patients in the 1,200 bed facility were infected by the virus with debilitating muscle aches and fever, although none in the ward that Dr. Cannell supervised contracted the disease. This observation was reinforced by an article in the FASEB Journal in 2005 by Adrian F. Gombart of the University of California at Los Angeles when he reported that Vitamin D boosted the production in white blood cells of one of the antimicrobial compounds that defends the body against germs.  This compound called cathelicidin targets microbes that include bacteria, viruses and fungal infections and will be reported in the December issue of epidemiology and infection.  The study noted the relationship between Vitamin D and susceptibility to tuberculosis, which is an extremely difficult infection to prevent or control. Scientists stress the importance of supplementing with Vitamin D3, which is the natural and active form of Vitamin D rather than the synthetic Vitamin D2, which is used for fortifying foods.  Furthermore, it is recommended that in getting the Vitamin D blood levels in the laboratory, it is important to measure the 25 hydroxy calciferol which is the active form of Vitamin D.  The normal range of Vitamin D in the blood is between 30 and 80ng/ml. but most scientists now agree that health is best maintained when the level is over 50ng/mL and a safe range for maintaining optimum health is between 50ng and 100ng/ml.   

Vitamin D deficiency has been associated with cancer of the colon, prostate, breast and skin.  Furthermore, it has been linked to tuberculosis, multiple sclerosis, depression, schizophrenia, seasonal affective disorder, hypertension, cardiovascular disease and several autoimmune diseases.  Research in the animal laboratory has shows that Vitamin D is necessary for maintaining balance by regulating the calcium flecks or “microliths” of the inner ear.  This versatile vitamin has also been shown to be necessary for muscle and tendon strength and reduction of sports injuries.

The usual recommended dose of 400 IU a day has been increased to 1,000 to 2,000 IU a day depending on the latitude, season, pigmentation, age and health of an individual.  It has been suggested that 10,000 IU a day could be taken safely in most circumstances.  50,000 IU a day has been given for a short term to patient’s with serious infections.  Although toxicity is rare, (most cases of Vitamin D overdose occurred due to manufacturing or industrial accidents and there has been only 300 cases reported with only one death) high dose Vitamin D supplementation should only be used in concert with your physician and baseline blood levels of Vitamin D3 and subsequent follow-up levels are recommended.  The presenting symptoms of Vitamin D deficiency are protean, ranging from depression to bone pain and one should always consider this a possibility where the circumstances fit.  Furthermore, since optimizing Vitamin D levels may be beneficial in so many disease states, it is advisable to determine a Vitamin D level in patients who have, or are susceptible to, the previously mentioned illnesses and implement supplementation when indicated. 

At the Integrative Center we have seen many people who are insufficient or deficient in Vitamin D and we have experienced a good response when correcting this problem.  In conclusion, Vitamin D deficiency is a common finding seen especially above 40 degree latitude and in darker individuals, older patients, in the winter or in people who avoid sunlight, use sunscreen or are chronically ill.  Quite often food intake is inadequate to meet the need and supplementation is advisable.  The deficiency of Vitamin D has been linked to many disease including cancer, heart disease, autoimmune diseases, neurologic diseases, infections, depression, multiple sclerosis, schizophrenia, tuberculosis and a host of other illnesses which may be prevented or ameliorated by this amazing micronutrient which is effective in so many diseases and which deficiency is in almost epidemic proportions in our country today.

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