Who is usually deficient in Vitamin D?
http://my.webmd.com/content/article/78/95751.htm
In the latest study, Gregory A. Plotnikoff, MD, of the University of Minnesota Medical School found a much higher incidence of vitamin D deficiency in the patients with unexplained muscle and skeletal pain than expected, regardless of their ages.
All of the African Americans, East Africans, Hispanics, and Native Americans who participated in the study were vitamin D deficient, as were all of the patients under the age of 30.
The researcher says it was a big surprise that the worst vitamin D deficiencies occurred in young people -- especially women of childbearing age. The findings are reported in the December issue of the journal Mayo Clinic Proceedings.
"The message here is that unexplained pain may very well be linked to a vitamin D deficiency," Plotnikoff tells WebMD. "My hope is that patients with unexplained pain will be tested for vitamin D status, and treated, if necessary."
http://www.washingtonpost.com/wp-dy...004May20_2.html
"The highest rate of prostate cancer is among African Americans, followed by countries in northern Europe. How are blacks like Scandinavians? They don't look alike, but in some important ways they have to be alike," said Gary G. Schwartz, a cancer researcher at Wake Forest University School of Medicine. "One way that they are alike is both groups have very low levels of vitamin D."
http://www.who.int/nut/vad.htmWhat's the minimum vitamin D necessary for good health for most people?
http://www.cholecalciferol-council....tal_illness.htm
EVIDENCE HUMANS NEED AT LEAST 3,000 IU OF VITAMIN D/DAY
Support for the growing realization that humans need a minimum of 3,000 IU of vitamin D a day (from all sources, diet, sun and supplements) includes:
1. Recent studies by Heaney et al conclude healthy men utilize between 3,000 and 5,000 IU of cholecalciferol a day, mostly from stores made by the summer sun. [21]
2. Humans living near the equator, where we evolved, have mean serum 25(OH)D levels of more than 40 ng/ml, levels requiring solar input of about 4,000 IU of vitamin D a day. [22] American lifeguards, working in swimsuits, have even higher 25(OH)D levels (64 ng/ml), in spite of temperate latitudes.[23]
3. In 2003, Gomez recently produced evidence that excessive secretion of the parathyroid gland (secondary hyperparathyroidism) is almost nonexistent when 25(OH)D levels exceed 30 ng/ml (requiring 3,000 IU of D a day). [24] Vieth cited six studies that concluded, if the aim is to keep parathyroid hormone concentrations low, 25(OH)D levels should exceed 28 ng/ml (70 nmol/L). [25]
4. Heaney and his colleagues recently showed that calcium absorption increases as 25(OH)D blood levels increase.[26] With blood levels of 34 ng/ml (equivalent to about 3,000 IU/day total intake), calcium absorption was 65% higher than when levels are 20 ng/ml. This implies that part of the reason humans need to take so much extra calcium is because there is widespread deficiency of vitamin D. when speaking of 25(OH)D blood levels, the authors were blunt, “We conclude that the lower end of the current reference range is set too low.”
5. Blood pressure is reduced significantly by ultraviolet radiation comparable to about oral intake of 3,000 IU of vitamin D a day [27] but blood pressure is not routinely reduced by small amounts of vitamin D.[28]
6. Daily doses of 2,500 IU of vitamin D helped rheumatoid arthritis [29] but small amounts did not.[30]
7. Infants receiving 2,000 IU a vitamin D a day were almost fully protected (relative risk 0.12) from developing type 1 diabetes 30 years later.[31]
8. 5,000 IU of vitamin D a day, along with calcium and magnesium, decreased the relapse rate in multiple sclerosis patients.[32] Multiple sclerosis is rare around the equator.[33]
9. To our knowledge, all studies of vitamin D and fractures demonstrate reduced fracture rates, as long as 25(OH)D levels increased to more than 40 ng/ml after treatment. [34] [35]
10. Breast milk (nature’s perfect food) is deficient in vitamin D. Does this mean Paleolithic humans were supposed to expose their young to the sun (and thus to predators)? Hollis recently discovered that breast-feeding mothers need 4,000 units of vitamin D a day to sustain themselves and their infant.[36] 2,000 units a day was not effective. It seems likely to the authors that the lack of vitamin D in human breast milk is due to widespread deficiency in mothers.[37]
10. Humans make thousands of units of vitamin D within minutes of whole body exposure to sunlight. From what we know of nature, it is unlikely such a system evolved by chance.
The definitive answer on vitamin D dosage
http://www.cure-guide.com/Natural_H.../vitamin_d.html
Babies
Babies' vitamin D stores at birth can be increased if their mothers have had adequate exposure to sunlight and/or adequate vitamin D intake during their pregnancies. Vitamin D is essential for bone growth in infancy and throughout childhood. The two reliable and safe sources of vitamin D for babies are sunlight and cod liver oil.
According to Barber and Purnell-O'Neal writing in Mothering Magazine, "a baby in a diaper needs a total of only 30 minutes of sunlight a week - less than five minutes a day. Fully clothed and without a hat, a baby would need two hours of sunlight a week, or about 20 minutes a day. Medium to darker skin tones need a little more time in the sun (Barber & Purnell-O'Neal, 2003)."
Avoid prolonged exposure to bright sunlight because of the danger of sunburn. Babies will get enough vitamin D if they have access to a bit of sun each day.
Babies that reside in North America and Europe may need vitamin D supplementation during the colder months of the year when sun exposure is not possible and weather prevents adequate exposure to the healthy rays of the sun.
Cod liver oil will provide vitamin D, vitamin A, and the omega-3 fats that stimulate brain development. Give one teaspoon for each 50 pounds of weight. A baby that weighs 10 pounds should get ¼ teaspoon, and a baby that weighs 20 pounds should get a little less than ½ teaspoon per day in the winter months. Use a source of cod liver oil that has been tested for contaminants (such as Carlson's brand). In the late spring through early autumn, give 100 mg of the omega-3 fat DHA from algae (Neuromins) or a fish oil supplement without vitamin D to babies who are eating solids. Babies that are solely breastfed do not need additional DHA if their mothers have an adequate intake of omega-3 fats, such as a fish oil or cod liver oil supplement. Breast milk normally has high levels of DHA, which can be increased by taking an omega-3 supplement.
==================================
Adults
It is safe to obtain vitamin D from the sun's UVB radiation or from foods. Vitamin D3 (cholecalciferol) is found in eggs, animal fat, and cod liver oil. Do not eat fish to secure vitamin D in your diet. The fish available to us is not safe to eat. Vitamin D2 (ergocalciferol) found in plants is less biologically active and is toxic at high dose levels, above 10,000 units per day.
Have your vitamin D levels tested before supplementing your diet. The correct test is 25-hydroxyvitamin D. Normal values, according to Dr. Joseph Mercola, are 45-55 ng/ml (115-140 nmol/l). Most lab reference ranges are too low.
Do not attempt to supplement your diet with significant amounts of vitamin D without adequate testing. Krispin Sullivan, author of the forthcoming vitamin D book Naked at Noon recommends frequent testing. "Minimum testing should not be less than every three months the first year and six months the second and third years. Elevated 25(OH)D may not show up in a blood test until as long as 2-3 years after starting an excessive dose" (
www.sunlightandvitamind.com).
The typical vitamin D dosage is 2,000-3,000 IU for a 150 pound person, or 1 teaspoon of cod liver oil for each 50 pounds of body weight. Sullivan recommends seeking out a health care provider knowledgeable in vitamin D supplementation. Use cod liver oil during the winter months and switch to a fish oil omega-3 supplement during months when exposed to sunshine is possible.
Do not use a daily sunscreen. Reserve sunscreen use for the prevention of sunburn during midday exposure in bright sunlight, when swimming, at the beach, and during snow sports. Then use only zinc oxide and titanium dioxide sunscreens either in a cream (Lavera, Dr. Hauschka, etc.) or micronized powder (ColorScience).
Before considering supplementation with vitamin D, it would be wise to have your vitamin D level tested. This is best done from a nutritionally oriented physician. It is very important that they order the correct test. The advantage of having your medical doctor perform the test is that it will usually be covered by your medical insurance.
Eventually, Krispin Sullivan, my nutritionist mentor in vitamin D, hopes to have an inexpensive saliva hormone test that you will be able to do through the mail. In the meantime, the blood test is the best route to monitor vitamin D levels at this time.
Don't Be Fooled -- Order the Correct Test
There are two vitamin D tests -- 1,25(OH)D and 25(OH)D.
25(OH)D is the better marker of overall D status. It is this marker that is most strongly associated with overall health.
The correct test is 25(OH)D, also called 25-hydroxyvitamin D
Please note the difference between normal and optimal. We don't want to be average here; we want to be optimally healthy.
Primitive man likely developed in tropical and sub-tropical conditions with large exposure to UV-B and its secondary consequence to skin exposure, vitamin D.
Primitive environmental availability of a nutrient does not necessarily establish the higher requirements, but these exposures would have influenced the evolution of the relevant physiology, and such concentrations should at least be considered presumptively acceptable.
Some experts may disagree with the following healthy ranges, but they are taken from healthy people from the tropical or subtropical parts of the world where they are receiving healthy sun exposures. It seems more than reasonable to assume that these values are in fact reflective of an optimal human requirement.
Dr. Michael Hollick is one of the top vitamin D researchers in the world and he has been advocating higher reference ranges, though not as high as the ones suggested here.
(Holick MF. Calcium and Vitamin D. Diagnostics and Therapeutics. Clin Lab Med. 2000 Sep;20(3):569-90)
Optimal 25-hydroxyvitamin D values are:
45-50 ng/ml or
115-128 nmol/l Normal 25-hydroxyvitamin D lab values are:
20-56 ng/ml
50-140 nmol/l
Your vitamin D level should NEVER be below 32 ng/ml. Any levels below 20 ng/ml are considered serious defiency states and will increase your risk of breast and prostate cancer and autoimmune diseases like MS and rheumatoid arthritis.
If you have the above test performed, please recognize that many commercial labs are using the older dated reference ranges. The above values are the newest ones from the clinical research.
Make Sure Your Lab Uses the Correct Assay
There are a number of different companies that have FDA approval to perform vitamin D testing. The gold standard company though is Diasorin. Quest labs is the largest commercial lab in the US and they use this company to measure 25 hydroxy D levels. However, many other commercial labs don’t. So if you do not have your test done at Quest labs please contact the lab directly to find out which assay is being used. Your test results will not be accurate and you can not use the values in the table above unless the D is measured with a Diasorin assay. The extra hassle is definitely worth it, believe me. You will only need to do this once though, as the labs do not switch assays. However, if your lab is not using the Diasorin assay you could ask them to switch to the gold standard.
How To Dose Your Vitamin D Once You Know Your Levels
Vitamin D is a fat soluble vitamin and can be quite toxic. Once you have vitamin D toxicity you can't easily turn it around.
So don't even think of starting this program unless you have your blood levels checked. Many of you may choose to ignore this warning, but I am telling you in plain simple English, that while vitamin D has enormous potential for improving your health, it has nearly equal potential to worsen it, if you use it improperly.
For safety purposes it is advisable to optimize your vitamin D levels only with the help of a trained health care professional. The exact protocol to optimize your vitamin D levels will be in Krispin Sullivan's upcoming book Naked at Noon. The book will have far more information than is in this brief review and will further highlight the importance of testing.
If you need to know this information before her book is published a preliminary copy of her vitamin D research is available on her Web site. While she has an e-mail listed on her site, please understand that she doesn't have time to respond to personal e-mails or her book will never be finished.
Krispin Sullivan and I share the same passion--seeking to help large numbers of people regain their health with inexpensive nutritional therapies. She has researched this subject for a number of years and, to the best of my knowledge, is one of the most experienced clinicians in this area. She has provided me with much of the foundational background for this review, and I am very grateful for her willingness to bring me up to speed in, not only this area, but also omega-3 nutrition and vitamin K.
Sunlight Is the Ideal Source of Vitamin D
Ideally, the best place to get vitamin D is from your skin being exposed to the UV-B that is in normal sunlight. Vitamin D from sunlight, or supplements, acts as a pro-hormone, rapidly converting into 25-hydroxyvitamin D.
Many experts believe that there is no harm in the vitamin D concentrations associated with sun exposure, and that such levels are probably optimal for human health.
Unfortunately, the amount of sun reaching most of the U.S. is only sufficient to generate a vitamin D response for about three months of the year.
Now, I can just hear scores of you getting alarmed that this recommendation will increase your risk of skin cancer. Well folks, nothing could be further from the truth.
I will provide all of the documentation and scientific research to support this assertion in future issues. But, I am convinced beyond any shadow of a doubt that as long as you avoid being sunburned, sun exposure at noon on unexposed skin is one of the healthiest things you can do for your body.
Most of us just don't live far south enough, or high enough in the mountains, to allow more UV-B to reach our skins. So, for those times of the year when access to the proper amount of sun is not possible, you will want to consider the cod liver oil recommendations above.
Ultraviolet-B Is What Generates Vitamin D In Your Skin
Ultraviolet (UV) light is divided into 3 bands, or wavelength ranges, which are referred to as UV-A, UV-B and UV-C.
UV-B is sometimes called the "burning ray." It's the primary cause of sunburn caused by overexposure to sunlight. However, UV-B sunlight produces vitamin D on the skin. The amount produced depends on exposure time, latitude and altitude of location, amount of skin surface exposed, skin pigmentation and season.
UV-B also stimulates the production of MSH, an important hormone in weight loss, energy production, and in giving you that wonderful tanned appearance.
However, UV-B does not penetrate very deeply into the skin. The darker the pigmentation or more tanned the skin, the less UV-B penetrates. Window glass allows only 5% of the UV-B light range that produces D to get into your home or auto.
The timing of your sun exposure is also a major factor. Sun exposure must take place when UV-B is present. The forthcoming UV-B meter, discussed below, should greatly aid in this assessment.
The actual dosing of the sun exposure is quite complex, since it involves knowing the amount of UV-B and one's skin color.
This doesn't sound very complex, but the amount of UV-B is not a constant. It is a major variable and is influenced by a number of factors:
• Latitude -- the further north you are the less there is
• Time of Year -- virtually none available in winter in continental U.S.
• Clouds -- can block UV-B
• Pollution -- smog and ozone can block UV-B
• Altitude -- the higher up you are the more UV-B reaches you
I am working with a company now to bring a very inexpensive UV-B meter so you can know exactly how much sunlight you need on any given day to generate an optimum vitamin D exposure. I hope to have that UV-B meter available later this year so you can use it to time your dose of sun exposure.
It is important to know the level of UV-B exposure. Unlike the typical American strategy, more is better, that is not the case for UV-B exposure. Longer exposure will not increase vitamin D production, but will increase the danger of skin damage and possible skin cancer.
Major Caution: Avoid Sunburn
Again, it is important to stress that you should never get burned and should only implement sun exposure very gradually.
While we all benefit from regular exposure to sun, it is important to recognize that you should always limit your exposure so that you don't get burnt. Sunburn has been clearly related to an increased risk of skin cancer.
Interestingly, if you don't get sunburned and actually have regular sun exposure, you will have a decreased risk of the dangerous skin cancer, melanoma.
However, don't let dermatologists scare you. We all need sun. It is very similar to water. Just because you can drown while swimming, doesn't mean you should never drink water or swim in it. Similarly, as long as we avoid sun exposure that will cause burning, it will help improve our health.
Later this year I will provide all the scientific documentation for this. It is a complex issue though. Skin cancer is largely related to the over abundance of omega 6 oils that we have in this country. When sunlight hits these fats it can convert them to cancer causing molecules, and if one is not healthy, these cells can go on to developing cancer.
This cancerous transformation doesn't happen with omega three fats. So, changing the ratio of omega 3 to omega 6 oils in your diet is one the keys to prevent this. The best sources of omega three fat would be cod liver oil and grass fed animals like beef.
Remember: Don't Ever Get Sun Burned
It is also important to point out the obvious. Fair skinned individuals need far less exposure to receive their dose of sun to produce vitamin D. Lighter skin allows for greater penetration of UV-B, leading to higher levels of D.
African Americans however, would need considerably more sun to generate vitamin D. This is one of the reasons why breast and prostate cancers are so much higher in Africans who are living in temperate climates. They just aren't able to get enough sun to generate vitamin D. In fact, in the Northern U.S. cities, they will find it impossible to get adequate D from sunlight in any season.
Elderly individuals will also have a great difficulty getting enough vitamin D from sun exposure, since an enzyme in their skin decreases with degenerative aging and, as a result, their skin has a limited capacity for producing vitamin D.
Interestingly, it is impossible to get vitamin D toxicity from too much sun exposure. Your body just won't let it happen. That is why receiving your vitamin D from the sun is the best option if possible.
Ultraviolet exposure beyond the minimal dose required to produce skin redness, does not increase vitamin D production any further.
An equilibrium occurs in white skin within 20 min of ultraviolet exposure, in which further increases in vitamin D is not possible, since the ultraviolet light will actually start to degrade the vitamin D.
It can take 3-6 times longer for pigmented skin to reach the equilibrium concentration of skin previtamin D. However, skin pigmentation does not affect the amount of vitamin D that can be obtained through sunshine exposure.
It is commonly thought that only occasional exposure of the face and hands to sunlight is "sufficient" for vitamin D nutrition. Indeed, this exposure can provide 200-400 IU vitamin D during those months when the appropriate sunlight is available.
Supplemental Vitamin D
Unfortunately the vast majority of us living in the U.S. just do not have access to the proper amount of sun most of the year. Even if the sun is out there, most of us are working during the week and don't have time to go out and capture some sunlight on our skins.
So, that leaves supplementation as the only practical option for most of us.
Vitamin D Toxicity
First, let me state that there are two types of vitamin D supplements: vitamin D3 (cholecalciferol) which comes from fish oil and plant source D2 (ergocalciferol) which is found in fortified foods and some supplements. D2, found in plants and made active by irradiation, is less biologically active.
Vitamin D3 is found in eggs, organ meats, animal fat, cod liver oil and fish. It is the equivalent to the vitamin D3 formed on our skins from UV-B.
You should stay away from the synthetic D2 as it is the one that has been shown to have toxicity at the higher dose ranges. You will only want to use vitamin D3.
There are newer reasons why vitamin D2 has a greater potential for harm. First, vitamin D binding protein has a weaker affinity for the vitamin D2 metabolites than vitamin D3. Second, unique biologically active metabolites are produced in humans from vitamin D2, but there are no analogous metabolites derived from vitamin D3.
There is no doubt that vitamin D2 is a synthetic analogue of vitamin D, with different characteristics. It is inappropriate to regard vitamin D2 as a vitamin. Future research into the toxicity of this vitamin needs to focus on vitamin D3 as being something distinct from vitamin D2, for which almost all our current toxicity data relate to.
Even without careful attention to the type of vitamin D being used, a recent expert review on vitamin D was unable to find any published evidence of vitamin D toxicity in adults from an intake of 10,000 IU per day that was verified by the blood 25(OH)D concentration.
People Who Should Not Take Supplemental Vitamin D
Some patients with sarcoidosis, tuberculosis, or lymphoma become hypercalcemic in response to any increase in vitamin D nutrition. For these persons, it may be wise to avoid any dietary or environmental sources of vitamin D, unless they are carefully monitored with serum calcium and 25(OH)D levels.
Although Mercola cautions about vitamin D toxicity, he later recants by this:
http://www.mercola.com/2003/dec/27/vitamin_d_quiz.htm
How Much Vitamin D is Too Much? Take This Vitamin D Quiz to Find Out!
Dr. Mercola's Comment:
There is much confusion about vitamin D and vitamin D toxicity. I encourage you to take the quiz and even pass it along to your doctor, as very few U.S. physicians are aware of vitamin D’s importance.
Winter is the time of year when most of us in the United States need to be very diligent about keeping our vitamin D levels within optimal levels. I recommend that most take a high-quality cod liver oil, which is an excellent source of vitamin D, regularly from fall until early spring. However, it is essential to understand that in order to know how much vitamin D you should be taking, you should get your blood level checked. If you use beneficial products like cod liver oil without doing blood tests for vitamin D levels, you should keep the dose at one to two teaspoons per day to prevent overdosing.
This is a major point: excess vitamin D will cause, not prevent, osteoporosis and hardening of your arteries. Please be very careful with cod liver oil. If you are unable to obtain vitamin D testing, then please do not exceed one to two teaspoons of cod liver oil. So please do yourself a favor--read the article on vitamin D testing and be sure to have your level measured. As I mentioned above, nearly all physicians are not aware how to have this checked and how to interpret the normal reference ranges, so I encourage you to print out the article on vitamin D testing not only for your own records but also for your doctor so he or she can become aware of this vitally important nutrient.
The Vitamin D Council, the non-profit group that contributed the excellent quiz below, is another great resource for vitamin D information. The Vitamin D Council is a group of citizens concerned about vitamin D deficiency and the diseases associated with that deficiency. I encourage you to check out their website and sign up for their informative newsletter. Their goal is an important one: to draw attention to the problem of vitamin D deficiency through the education of professionals, the media, government officials and average citizens.
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By John Jacob Cannell, M.D.
Executive director of The Vitamin D Council
1. If an otherwise healthy adult tried to kill himself by taking an entire bottle (250 capsules) of 1,000 iu cholecalciferol, which of the following would happen?
a) The person would die within 24 hours from severe hypercalcemia and widespread calcinosis.
b) If the person received intensive treatment for hypercalcemia he may survive.
c) Hypercalcemia would be severe but require only supportive treatment.
d) Such doses are called "Stoss" therapy and are occasionally used therapeutically although they do not replicate normal physiology. As most Americans are vitamin D deficient, such a one-time dose would probably be a health benefit for the majority of Americans.
The correct answer is d. One of the most recent examples is the use of stoss therapy to reduce fracture rates in the elderly (100,000 IU of oral cholecalciferol every four months for five years) by Dr. Trivedi and colleagues (University of Cambridge School of Clinical Medicine) published in the British Medical Journal. How high do you think average 25-hydroxyvitamin D levels were in the subjects after they received 100,000 IU of cholecalciferol every four months for five years? Answer: about 29 ng/ml, still mildly deficient! (Source)
2. Acute poisoning leading to rapid death from ingestion of vitamin d capsules (successful suicide attempt),
a) Has frequently been reported in the literature.
b) Has occasionally been reported in the literature
c) Has never been reported in the literature.
The answer is C, as far as we know. If you know of a report of a successful suicide attempt, accidental death or murder from overdosing on vitamin D supplements, let us know. We do know of one interesting case that demonstrates the relative safety of vitamin D. Industrial strength crystalline vitamin D was added to table sugar, either by accident or on purpose. The two men poisoned were getting about 1,700,000 IU of cholecalciferol every day for seven months. Again, they were getting at least, 1,700,000 units [440 times the Institute of Medicine's toxicity warning (LOAEL)] every day for seven months! Both got very sick but recovered. (Source)
3. True of false: water has a higher (safer) therapeutic index (the median lethal dose divided by the median effective dose) than cholecalciferol?
a) True
b) False
c) About the same
The answer is b. Although exact human studies have never been done for obvious ethical reasons, water intoxication leading to hyponatremia, cerebral edema and occasional death is common in psychiatric populations and may become evident if one drank 80 glasses of water a day, instead of eight. Heaney, et al, recently showed healthy humans utilize about 4,000 IU of cholecalciferol a day, if they can get it. 40,000 IU a day is certainly not acutely toxic. In fact, some research reported that young white humans get up to 50,000 IU from one full body summer sun exposure. (Source)
4. If a person totally avoided the sun and regularly took two standard multivitamins a day for several years, each containing 400 iu of ergocalciferol, as his sole source of vitamin d, he would,
a) Rapidly become vitamin D toxic and require medical attention for symptoms of hypercalcemia.
b) Slowly become vitamin D toxic and eventually become symptomatic.
c) Slowly develop hypervitaminosis D but remain asymptomatic.
d) Obtain a healthful vitamin D blood level.
e) Inexorably become vitamin D deficient.
The answer is e. Two standard multivitamins contain 800 IU of ergocalciferol, equivalent to about 500 IU of cholecalciferol. If you totally avoided the sun, as many dermatologists routinely recommend with impunity (so far), one would have enough vitamin D to prevent rickets and osteomalacia but would still have a suboptimal 25-hydroxyvitamin D and thus be at risk to develop numerous other chronic inflammatory diseases, not just osteoporosis. For a review of such illnesses, see Zittermann. (Source)
The key is "totally avoided the sun." Remember, most people get 90 percent of their vitamin D requirement from very casual sun exposure, like the sunlight that strikes the uncovered and unsunblocked face, arms and hands when you walk to your car. Vitamin D production in the skin is that fast. Of course, some people follow their doctor's advice and take obsessive steps to prevent sunlight from ever striking their unprotected skin. A host of chronic inflammatory diseases may await the patients who follow such advice, just as trial lawyers may await the doctors that give it.
5. Of the three medications listed below, which is the safest in overdose?
a) Vitamin D (250 of the 1,000 IU capsules)
b) Aspirin (250 of the 325 mg tablets)
c) Tylenol (250 of the 500 mg tablets)
The answer is a. In fact 250,000 IU of vitamin D at one time is used as "stoss" therapy, especially in Europe. For a review of many such studies and the doses needed to achieve toxic 25-hydroxyvitamin D levels, see Vieth. (Source)
6. Which drug has the highest (safest) therapeutic index?
a) Depakote
b) Lithium
c) Coumadin
d) Dilantin
e) Synthroid
f) Theophylline
g) Cholecalciferol
The answer is g. All of the medication listed except cholecalciferol have narrow therapeutic indices and can easily cause death in overdose. Such is not true for vitamin D and, because of the huge number of capsules needed, is not likely unless one has the industrial strength compound. See below for a sample calculation.
7. In 1997, adams and lee wrote a widely publicized paper about vitamin d toxicity in the annals of internal medicine. The adams and lee paper was accompanied by a stern editorial warning of the dangers of vitamin d written by marriott of the national institute of health. The three authors,
a) Correctly diagnosed all five of the patients
b) Were thanked by nationally acclaimed vitamin D scientists for their contributions to understanding vitamin D toxicity.
c) Showed frightening ignorance about vitamin D toxicity and appeared not to know the difference between the two standard deviation upper limit of a Gaussian distribution and levels known to reflect vitamin D toxicity.
The Adams and Lee paper and the editorial by Dr. Marriott are a continued embarrassment to the usually stellar Annals of Internal Medicine. However, the papers are instructive in that they remind us that otherwise educated and intelligent research physicians can confuse the two standard deviation upper limits of a Gaussian distribution with toxicity. For a more detailed critique, as well as several other problematic articles about vitamin D, see this link.
8. By sunbathing for a few minutes in the noonday summer sun, one can easily obtain five times the vitamin d toxicity warning (lowest observed adverse effects level or loael) of the institute of medicine's food and nutrition board.
a) True
b) False
The answer is a, at least for young whites. The IOM lists the Lowest Observed Adverse Effects Level (LOAEL) as 3800 IU for vitamin D. Studies show young whites can make between 10,000 to 25,000 IU in a single, relatively brief, sun exposure. Numerous factors affect the body's ability to make such high amounts of cholecalciferol, with age, race, latitude, clothing, season and sunblock being the main factors. (Source)
9. If humans are twice as sensitive as the most sensitive mammal tested (male rats), then a 110-pound human would have to injest 88,000 capsules (352 bottles containing 250 of the 1,000 iu capsules) of cholecalciferol in order to have a 50 percent chance of dying (ld50) from an acute overdose.
a) True
b) False
False, about 168 bottles would do it. The LD50 for male rats (the most sensitive mammal tested) is 42 mg/kg. If humans were twice as sensitive that would be an LD50 of 21mg/kg or 21,000 ug/kg or 1,050,000 ug for a 50 kg human which is 42,000,000 units or 42,000 capsules or 168 bottles of the 250 capsules of 1,000 IU cholecalciferol. [Dorman DC (1990) Toxicology of selected pesticides, drugs, and chemicals. Anticoagulant, cholecalciferol, and bromethalin-based rodenticides. Vet Clin North Am Small Anim Pract 20(2):339-352].
10) As most american blacks suffer from vitamin d deficiency, some black activists feel unwarranted fear and scare techniques about vitamin d toxicity may be racially motivated. That is, racists may be intentionally repeating and promulgating vitamin d toxicity scares in order to prevent relevant government agencies from dealing with the problem of widespread vitamin d deficiency in the black community.
a) True
b) False
True. The recent NIH conference on vitamin D was most interesting in this regard. Very few Blacks were attendees but several were helping with registration. As the conference progressed into the second day, Blacks helping with registration began to listen to the lectures and became increasingly angry as speaker after speaker pointed out how vitamin D deficiency adversely impacts the black community. One young black man told a sad story of how his infant son was recently diagnosed with rickets. Although the 1997 Food and Nutrition Board was an all-white board, most of the Blacks were angry that nothing is being done currently.
Certainly, it is true that one of the most effective ways to paralyze the government into continued inaction on the pandemic of vitamin D deficiency would be to raise false and frightening toxicity fears. However, remember that it is easy to suspect vast conspiracies, but in the end it is usually simple incompetence. That is certainly true of the mistakes I've made in my life.
11. In the most recent case of vitamin d toxicity described in the literature, a man recovered uneventfully after taking a health supplement every day for two years that contained 156,000 iu of cholecalciferol.
a) True
b) False
True. Actually, it is likely he took more than that. An industrial manufacturing error was implicated. Such reports help confirm what is known from animal data and that is that it takes a lot of vitamin D to hurt you, but it can be done. (Source)
12. One of the world's foremost authorities on vitamin d metabolism and physiology recently said, "worrying about vitamin d toxicity is like worrying about drowning when you are dying of thirst."
a) True
b) False
True. The quote is from one of the vitamin D scientists listed below. One of the problems is that there are so few vitamin D scientists in the world, that misconceptions, especially about toxicity, are the rule rather than the exception, even among medical researchers.
In 1999, Dr. Reinhold Vieth, perhaps the world's leading expert on vitamin D toxicity and metabolism, wrote a systematic and scholarly review of the world's literature debunking the hysteria surrounding fears of vitamin D toxicity. (Source)
Later, Vieth demonstrated the safety of daily dosing with 4,000 IU of cholecalciferol, a dose that exceeded the current toxicity warnings of the IOM's FNB. (Source)
Two years later, Heaney, et al, demonstrated the safety of doses up to 10,000 IU a day while also demonstrating for the first time that healthy humans utilize 3,000 to 5,000 IU of cholecalciferol a day (10 times the Institute of Medicine Food and Nutrition Board's current recommended Adequate Intake). What the human body does with such high amounts of cholecalciferol remains unknown, but we suspect Nature has a plan. (Source)
In a reply to critics of his paper, Vieth challenged anyone in the scientific community to present even a single case of vitamin D toxicity in adults from ingestion of up to 1,000 ug (40,000 IU) a day of cholecalciferol saying, "I welcome any discussion of evidence of harm with vitamin D3 (not D2) in adults at doses <1,000 ug/d." Vieth's challenge remains unanswered and his work remains unrefuted. (Source)
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Another concuring view quoting actual studies:
http://stopcancer.com/Barefoot&DeWi...cerDefense2.htm
Vitamin D God Versus the A.M.A. by Robert Barefoot
Today, as never before, the American public is being bombarded with a barrage of medical misinformation designed to make the richest industry, drugs and pharmaceuticals, even richer. The statements either emanate (come out from a source) or are being supported by the medical prestigious (marked by illusion or trickery) American Medical Association, commonly known as the AMA. The statements, when viewed up close, appear to be made for the protection of the public; however, when viewed as a whole form at a distance, they can be interpreted as having the opposite effect. For example, "You don't need your gall bladder", even though it serves a useful biological function. Not only does this statement imply that God did not know what he was doing when he created man, but also the statement gives justification for the multi billion dollar assembly line removal of over 1,000,000 gall bladders a year in America. Another example is, "The sun is bad for you, it can cause cancer." Not only does this statement, once again, imply that God made a mistake when he created the solar system, but it also provides support for the multi billion dollar sun block industry. The tragedy is that, not only does the sun help the plants and animals to flourish, there is massive scientific evidence to show that the human body needs sunshine to provide good health. Although there are dozens more examples of statements inferring that the AMA is right and God is wrong, the most devastating to human health is the statement that Vitamin-D in excess is toxic. The measure of excess is their Recommended Daily Allowance, or RDA, which, in the case of vitamin-D, is 400 International Units (I U's) daily. Although 400 may sound like a big number, 400 IUs of vitamin-D is less than 0.01 milligrams. For those who do not understand just what a milligram is, a grain of salt weighs several milligrams. Thus the yearly RDA for vitamin-D designed by God is less than a grain of salt, and anything in excess of this, according to the AMA, "may be toxic". To understand why this ridiculously low recommended consumption is devastating to human health, one must review the history of vitamin-D.
To begin with, toxicity is defined as "the ability of a substance to cause injury to living tissue once it reaches susceptible site in or on the body". Based on this definition, almost all drugs are toxic. However, when a doctor tells a patient that something "is toxic", almost always, the patient believes that the doctor means that "it can kill you". Unfortunately, the doctors common referral to "too much" vitamins and minerals as toxic is more than often interpreted as meaning that they can be "lethal". Both history and scientific studies have shown this not to be true when taken in reasonable amounts. The question then becomes, "just what is a reasonable amount and what is too much?". Nutritionists believe that the amounts that should be consumed are often 2 to 100 times the recommended daily allowance (RDA). Scientific testing has shown that such amounts are both safe and effective. However, when seeking justification for the rash toxic statements, modern medicine resorts to studies where the amounts consumed are tens of thousands of times the RDA. Of course this is unreasonable if logic were to prevail.
When one, studies the massive scientific documentation on tests carried out by world recognized scientists, one has to almost conclude that their has been a conspiracy to maintain the myth that vitamins and minerals can be harmful to your health. To present this information in a form that the public could understand would take several books. However, because of the importance of vitamin-D in the prevention of disease and aging, and because of the fact that, except for health stores, it basically remains off of the shelves, and when found, it is only in tiny amounts too small to be effective. Examples of such studies are as follows:
After vitamin-D was removed from the market following the toxic effects that massive doses had on seven medical students, the public, who commonly took mega doses (millions of I.U.s) daily and claimed dramatic health benefits, demanded a fair study. One of the first and largest, Further Studies on Intoxication With Vitamin-D, was done by the University of Illinois, Chicago, Annuals of Internal Medicine, Volume 10, Number 7, January 1937, and took nine years to complete. They concluded that " Early experience with impure preparations of Vitamin D has lead to a get deal of misunderstanding and fear of over dosage on the part of those who have little acquaintance with the fundamental mechanisms involved. Suffice it to say that most of the earlier work must be disregarded. They also noted that both human subjects and dogs generally survive the administration of 20,000 I.U. per kilogram (14,545,000 I.U for a 160 pound man) per day for indefinite periods without intoxication." They further concluded that, "In view of the extensive experience in administration of vitamin-D to human subjects with a relatively low incidence of toxicity, and the correlation of the results of animal experiments with the observations on human subjects, we believe that the burden of proof now rests on those who maintain the undesirability of the use of this form (high daily doses of Vitamin D) of therapy.
Another study, A Preliminary Report on Activated Ergosterol (A form of High Dosage Vitamin-D in the Treatment of Chronic Arthritis), by G. Garfield Snyder, M.D., F.A.C.P., Willard H. Squires, M.D., F.A.C.P., New York State Journal of Medicine, May 1, 1940, pp 708-719, which used doses over 750 times the RDA of vitamin-D, concluded " We are inclined to agree with Reed Struck and Streck that the hazards of toxicity in high dose vitamin-D therapy have been greatly exaggerated” as "the degree of clinical improvement has been marked and sustained” and “No serious toxic manifestations were encountered.”
Another study, Follow-up Study of Arthritic Patients Treated with Activated Vaporized Sterol, by R. Garfield Snyder, M.D., F.A.C.P., Willard H. Squires, M.D., F.A.C.P., New York State journal of Medicine, December, 1941 concluded that "the use of high doses of activated Vitamin-D is not associated with any more danger than is usually encountered with other accepted forms of therapy.”
The study, Comparative Therapeutic Value and Toxicity of Various Types of Vitamin-D by Chapman Reynolds, M. D. , Louisiana State University School of Medicine, The Journal Lancet, Minneapolis, October, 1942, Vol LXII, No.10, page 372, reported that the treatment of arthritis with massive doses (thousands of times the minimum treatment of 10,000 IU) of vitamin-D led to favorable results with no toxic reactions. This study also shows that the original toxic effects that resulted form taking thousands of times the minimal requirement (over 250,000 times the current RDA), were not caused by the vitamin-D but were caused by the impurities of using the pre 1932 solvent extraction procedure to produce the vitamin-D. It also concluded that the same amounts of the newer and cleaner form of vitamin-D produced by the Whittier process, used exclusively after 1932, was both non-toxic and beneficial to health.
In the study, The treatment of Arthritis By Electrically Activated Baporized Ergosterol, by G. Norris, M.D., Rheumatism, July 1947, pages 56-60, vitarnin-D in massive dosage is of great value in the treatment of arthritis, and that toxic effects are so rare or so temporary as to constitute no obstacle to its use.
The forgoing were just a few of the many prestigious scientific reports done by credible world renown scientists working in famous research institutions who gave powerful evidence to the fact that vitamin-D was not toxic. Many more credible reports exist which demonstrate the benefits of vitamin-D to human health, and can be found in the book The Calcium Factor by Carl Reich, M.D. and Robert Barefoot, Chemist. The few negative reports that could be found did not stand the test of scientific credibility, such as clinical research done in the name of scientific research by doctors experimenting on only a few patients for a short time and with no quality control. Unfortunately, they are telling there leaders in the AMA what they want to hear, so the real massive scientific research which contradicts these feeble findings is removed from the doctor's vision. Nevertheless, vitamin-D, designed by God, has been scientifically proven to be both beneficial to human health and non toxic.
The conclusion of an actual study of the safety of vit D3 at different levels
http://www.direct-ms.org/articles/V...SafetyStudy.pdf
Throughout the history of vitamin D supplementation in North America, high-dose preparations of the vitamin D2 form have generally been used. Vitamin D3 is common in lower-dose regimens, but in some parts of the world vitamin D2 is the only form licensed for use. In terms of rickets prevention, research from the 1930s was inconclusive at detecting a difference in efficacy between the 2 forms of vitamin D; therefore, pharmacopoeias continue to regard vitamin D2 as being equivalent to vitamin D3,
292 VIETH ET AL FIGURE 3. Total serum calcium concentrations and urinary calcium-creatinine excretion ratios at baseline (0 mo) and during supplementation with 25 (A and C) and 100 (B and D) g vitamin D3/d. The heavy line in each panel is the nonparametric, locally weighted regression and smoothing scatter plot. The dotted lines reflect the upper limit of the central 95% CI for the mean change. The value of each dotted line was calculated by adding the upper limit value (97.5%) for the mean change from baseline at each time point to the mean baseline value (month 0) for each group (repeated-measures
ANOVA followed by Dunnett’s test). even though the latter form is more effective at raising serum
25(OH)D concentrations (20). What seems to have been forgotten nis that the literature of half a century ago established that, at high doses, there was a greater risk of toxicity with what was called “the purely artificial” compound, vitamin D2 (38–40). One explanation for the difference in toxicity was the poorer stability and greater impurity of vitamin D2 than of vitamin D3 preparations (38). There are newer reasons why vitamin D2 has a greater potential for harm. First, vitamin D binding protein has a weaker
affinity for the vitamin D2 metabolites than for 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3 (41–43). This means that the proportions of free 25-hydroxyvitamin D2 and 1,25-dihydroxyvitamin
D2 are higher and more biologically available. Second, unique biologically active metabolites are produced from vitamin D2 in humans and there are no analogous metabolites derived from vitamin D3 (44). There is no doubt that vitamin D2 is a synthetic analogue of vitamin D, with different haracteristics.
It is an anachronism to regard vitamin D2 as a vitamin. Future research into the toxicology of this vitamin needs to focus on vitamin D3 as being something distinct from vitamin D2, for which almost all our current toxicity data relate to. The working definition of the recommended dietary allowance has been to ensure “levels of intake of essential nutrients considered, in the judgment of the Food and Nutrition Board on the basis of available scientific knowledge, to be adequate to meet the known nutritional needs of practically all healthy persons” (2, 6). For vitamin D, the relevant question could be, what 25(OH)D
concentration is desirable and how much vitamin D is needed to ensure that most adults attain this intake (45)? We did not measure PTH in this study, so we cannot address the question of what the desirable vitamin D intake is. However, the present results do provide insights into the lowest 25(OH)D concentrations that can be reasonably ensured in adults consuming 25 and 100 g vitamin D3/d. The 25- g/d intake offered reasonable assurance that serum 25(OH)D concentrations in adults would be > 40 nmol/L, but did not ensure that most subjects would attain serum 25(OH)D concentrations considered desirable (> 75 nmol/L). The 100- g/d intake offered reasonable assurance that 25(OH)D concentrations
in adults would be > 69 nmol/L (Figures 1 and 2), close to the lower end of the desirable concentration.
If the serum 25(OH)D concentration is the appropriate measure of vitamin D nutritional adequacy (1), then more of the present type of specific data are needed to define the amounts of vitamin D required to ensure that for “practically all healthy persons” serum 25(OH)D concentrations are maintained above an
amount considered adequate. There are subgroups who require ≥25 g vitamin D/d to maintain acceptable 25(OH)D concentrations. Gloth et al (46) reported that in older patients with 25(OH)D concentrations < 25 nmol/L, vitamin D intakes ranged as high as 29 g/d. Patients with cystic fibrosis require > 20 g vitamin D/d to maintain 25(OH)D concentrations > 40 nmol/L (47). Despite the greater number of subjects and the longer follow-up in the present study than in previous comparable studies
(3, 18, 19), consumption of vitamin D3 at intakes ≥100 g/d causes no harm and effectively raises 25(OH)D to high-normal concentrations in practically all adults.
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