The Vitamin D Newsletter May, 2006 This is a periodic newsl, a non-profit trying to end the epidemic of vitamin D deficiency. If you don't want to get the newsletter, please, please, please, hit reply and let me know. This newsletter is not copyrighted. Please reproduce it and post it on Internet sites. Not yet signed up for t and follow the directions. This month we will start with a question from a reader in Chicago and then see if the Vitamin D Conference just finished in Victoria, British Columbia, answered any of his questions. Dear Dr. Cannell: I have been following the research on Vitamin D for several years now - ever since I learned of the connection between vitamin D and multiple sclerosis (my father died from that disease.) I have also been receiving your very interesting newsletter and review the Cholecalciferol Council website frequently. My training is in physics, biochemistry, and anthropology from Stanford, and have several publications in chemistry, pharmacology, and laser physics so I appreciate the scientific updates. I am currently 42 years old. I had a few questions for you which I was hoping you might be able to address. I also wanted to give you some anecdotal evidence of my own experience with vitamin D, for what that's worth. I understand whatever reply you might give to me does not constitute "medical advice," but just your opinion. About a year ago, I started taking about 2000 units of cholecalciferol a day (sometimes 4000 a day) - I noticed no significant differences in my health either good or bad. This winter I received your update about vitamin D and influenza. Not long after this, I came down with the flu - a very bad case. I had read most of Heaney's articles on Vitamin D, as well as Holick's and others', so I knew that the human body can produce about 10,000 units a day in the summer sun in only 15-30 minutes, and had read all the statistics on Vitamin D overdose and toxicity, so I figured that upping my intake to 10,000 units a day for a few weeks might help me get over my terrible flu quicker, and certainly couldn't hurt me. I did up my intake to that level (this was about February 12th). It did not seem to speed up the recovery from my cold. I was pretty sick for two-three weeks. However, after the cold ended, I started to notice several good things happening to my body. Things much improved. The first thing that I noticed was that certain signs of inflammation that have been a problem for me for many years went away. I have had major periodontal disease for about 10 years, and nothing has helped very much. However in about a month of taking 10,000 units a day of cholecalciferol, much of my gum tissue healed significantly, stopped receding and became significantly less painful. I was overjoyed! In addition to this, my skin - which has often been red and inflamed (not psoriasis or anything clinical, just very red) became much better - clear, smooth and not red. The redness almost entirely disappeared! Five other things improved noticeably as well. My sense of smell became, I would estimate, 5 times as sensitive as it had been. I guess my sense of smell was just average before - but now all of a sudden, I can smell all kinds of subtle distinctions that I never could before. It is EXTREMELY noticeable. In addition to this, my sense of balance improved markedly and my guitar playing improved (I'm able to shift cords faster). Additionally, I began to sleep much better. The fourth thing I noticed was that my mood brightened noticeably - I was just happier. Finally, (and this is a little embarrassing) my semen quality and quantity went way up. Does vitamin D help semen? As you can well imagine, I was overjoyed, feeling like I had found some magic fountain of healing for many of my ailments. I felt like an almost new person-the improvements to my life were NOT subtle!! Then, my doctor told me 10,000 units a day was toxic. Immediately after that, I started becoming nauseous every time I took vitamin D. Could I be toxic? Philip, Chicago. Dear Philip: If you are toxic from vitamin D, you are the first person in the world to become toxic after taking 10,000 units a day for two months. That said, you need to have a 25(OH)D and calcium blood test. I predict your level will be about 80 ng/ml, well below the toxic range, and your blood calcium to be normal. However, in my opinion, everyone taking more than 2,000 units per day should have periodic 25(OH)D levels until the government changes its Upper Limit. By the way, unless you are fighting a life-threatening disease, there is just no reason to regularly take more than 5,000 units a day, and then only in the winter unless you assiduously avoid sunlight. I'm not surprised that 10,000 units per day had no effect on the flu. In my experience, one has to take 1,000 units per kilogram of body weight for three days early in the course of the illness to have an effect (that's 50,000 units a day for three days for a 110-pound person, taken early in the course of the illness - just like antivirals). As far as the other benefits you described, I have heard them all, except for the improved sense of smell. You'll be interested in what scientists reported in Victoria. Victoria Conference
The Vitamin D Conference just finished in Victoria was nothing short of spectacular. On the bus into Victoria, I met a representative from the National Cancer Institute whose job was simple: her bosses at the NIH wanted to know if they should fund the flood of grant requests about vitamin D. Given the quality of the papers presented, I can't imagine her answer was anything but yes. Dr. Tony Norman and Dr. Roger Bouillon, the conference organizers, had to choose from over 300 submissions from scientists around the world. The venerable Dr. Bouillon did not try to. Both men did a great job balancing presentations on vitamin D nutrition, vitamin D basic science, and the patentable vitamin D analogs sought by drug companies. Of course, I thought more time should have been devoted to vitamin D nutrition but Dr. Norman pointed out that more time was devoted to vitamin D nutrition than ever before. Like Dr. Norman, I am unable to comment on all the presentations that merited it, or this newsletter would be 50 pages long. It was painful to hear the scientists use ten different names (and interchangeably) for vitamin D, for 25-hydroxy-cholecalciferol, and for 1,25- dihydroxy-cholecalciferol. Some even called ergocalciferol vitamin D! Can you imagine scientists using the same name for cholesterol, pregnenolone, testosterone, and estradiol? They do exactly that with vitamin D. Editors of the major journals will not accept reasonable names like "vitamin D" for cholecalciferol, "calcidiol" for 25-hydroxy-cholecalciferol, and "calcitriol" for 1,25-dihydroxy-cholecalciferol. The presentations would have been much smoother if scientists could get together and give vitamin D and its metabolites common names like other steroid hormones. Dr. Barbara Gilchrest, who fired Dr. Michael Holick from one of his professorships several years ago after Holick wrote a book saying God knew what she was doing when she created sunlight, gave the Plenary Lecture. Wisely, Dr. Gilchrest overwhelmed the audience with graphic pictures of invasive skin cancer to support her argument that sunlight is evil. Of course, it's harder to show pictures of invasive colon cancer, breast cancer, prostate cancer, and the 15 other internal cancers caused by sunlight deprivation. However, Dr. Gilchrest is changing her mind. George Bernard Shaw once said, "Progress is impossible without change; and those who cannot change their minds, cannot change anything." Dr. Gilchrest is changing her mind - not about the evils of sunlight - about vitamin D. She is in the process of admitting that this miraculous substance has benefits beyond bone. Two years ago, she dismissed any concerns about vitamin D with a "take a multivitamin if you are concerned." Now she believes the Food and Nutrition Board needs to consider raising both the Adequate Intake recommendations
(how much one should take every day) as well as the Upper Level (the amount one can take on your own, without being under a doctor's care, and without fear of toxicity). My compliments to Dr. Gilchrest. One of the most interesting things I learned in Victoria is that scientists from England, Canada, New Zealand, Australia, and the rest of the world, do not understand the "American Decade Rule." The rule clearly states that if a U.S. scientist and a foreign scientist both discover the same thing in the same decade, the American gets total credit for it, even if the foreigner discovered it first. Case in point: the discovery of the potent steroid hormone, activated vitamin D or calcitriol, a discovery so important that it regularly starts rumors of a Nobel Prize. Dr. Holick, Dr. Schnoes, and Dr. DeLuca announced their discovery of calcitriol in April of 1971. A group in England, led by Dr. Lawson and Williams, published the same discovery in Nature, in March of 1971, a month earlier. Members of the same English group, Dr. Fraser and Dr. Kodicek, discovered the kidneys make calcitriol in November of 1970, a full six months earlier. However, both English discoveries were within a decade of the Americans. Therefore, the "American Decade Rule" applies and the Americans get total credit. I was surprised that scientists from the Commonwealth find the rule so hard to understand. Dr. Heike Bischoff-Ferrari did a wonderful job, not just presenting her data that optimal vitamin D blood levels need to be at least 40 ng/ml, but for presenting Dr. Ed Giovannucci's data (who had to cancel for personal reasons). Dr. Bischoff-Ferrari reminded us that periodontal disease in inversely related to vitamin D blood levels. She also reminded us that there is strong scientific evidence that vitamin D improves neuromuscular performance in older people. She didn't tackle the logical next question: will adequate levels of one of the most potent steroid hormones in the body improve neuromuscular performance in younger people, such as that need for optimal athletic or musical performance? Philip, whose email to me is above, and other readers of this newsletter have been telling me: yes, yes, yes. Dr. Bischoff-Ferrari then presented Dr. Giovannucci's data that one reduces your risk of all cancers about 17% for every 10 ng/ml of vitamin D in your blood. For cancer of the digestive system, the risk reduction is 43%. His data indicates all Americans should be taking about 2,000 IU per day and some Americans need even more to minimize cancer risk. No one know where the curve flattens out; that is, no one knows how much further cancer reduction one gets from 20, 30, or 40 ng/ml incremental increases in blood levels. The section on the enzymes that metabolize vitamin D reminded me how much we don't know about vitamin D. Millions of Americans take psychiatric and other
medications that interfere with the same system of enzymes (cytochrome P-450) that metabolize vitamin D. We've known for a long time that some medications taken for epilepsy (Dilantin, phenobarbital, Tegretol) reduce vitamin D blood levels. However, which medications increase levels? I have seen a number of cases of higher than expected levels in patients taking psychiatric medications metabolized by cytochrome P-450 enzymes and some non-psychiatric medications interfere with these same enzymes. This practical area of clinical medicine needs more research. Dr. Robert Heaney presented by video hookup and made his quiet but powerful case that about 75% of American women are vitamin D deficient (levels less than 35 ng/ml), that about 3,000 units a day are needed to bring 95 % of the population out of the deficient range, and that 10,000 units a day is the safe upper limit. (This does not mean you should take 10,000 units per day, it means scientists should be able to study 10,000 unit daily doses without the bureaucratic difficulty they now encounter). Dr. Kimball, working with Dr. Reinhold Vieth, presented data that children (age 10 -17) only increased their average blood level by 11 ng/ml when given 14,000 units per week for eight weeks and that such dosing was safe. Dr. Vieth is also trying to fill another need in vitamin D clinical science. We need a trial of healthy volunteers taking 20,000 units per day for two or three years. Do blood levels stabilize with oral dosing as they do with sun exposure? Does skin production produce other vitamin D compounds, like dihydrotachysterol, which inhibits the production of calcitriol and thus protects against vitamin D toxicity? Do other vitamin D variants made in the skin induce the metabolism of vitamin D, lower levels, and protect against toxicity? Does 20,000 units a day for years have any ill effects? Does it affect blood or urine calcium? One study from the 1980's showed 10,000 units a day caused loss in bone density but they used a vitamin D analog (ergocalciferol) which is a xenobiotic (generally foreign to the human body). Therefore, we still don't know what 20,000 units of real vitamin D (cholecalciferol) would do if given for several years. Dr. Bruce Hollis presented data that reminded us of two overlooked facts: (1) techniques to measure vitamin D in the blood have significant reliability problems, and (2) vitamin D is the only steroid hormone system in the body in which substrate starvation is the rule. That is, only the vitamin D steroid hormone system is chronically short of the substance needed (vitamin D) to fully activate the system. Dr. Reinhold Vieth discussed the second fact in his chapter in Feldman's most recent, and invaluable, textbook: Vitamin D. Dr. Hollis presented evidence in Victoria that levels of at least 40 ng/ml are required to normalize the enzyme kinetics of vitamin D. [When I say vitamin D
blood levels, I'm referring to 25(OH)D levels; Bruce is studying actual vitamin D levels (cholecalciferol) as well as 25(OH)D levels]. Dr. Hollis continues giving pregnant and lactating South Carolina women about 4,000 to 6,000 units a day in an ongoing study. We predict easier pregnancies and less depression in the moms - lower prenatal and perinatal mortality, fewer birth defects, fewer infections, less diabetes, less psychiatric illness, less asthma, stronger bones, and higher IQs in the children. Dr. Paul Lips and Dr. Susan Whiting presented upsetting evidence that vitamin D deficiency is the rule in most of the world; one exception is the Scandinavian countries were vitamin D levels are the highest in Europe, probably due to their cod liver oil. Unfortunately, hip fractures in these same countries are the highest in Europe, probably from the excessive vitamin A in cod liver oil. Stay away from cod liver oil. Dr. Hathcock did a great job reviewing the evidence that doses below 10,000 units per day have never been shown to be toxic and that 10,000, not 2,000, units per day should be the Upper Limit. He, like so many others, urged the Food and Nutrition Board to revise their outdated recommendations. Moreover, I understand from knowledgeable people at the conference that the Food and Nutrition Board is planning to do just that. Yes!!!!!! Dr. Dixon presented fascinating evidence that high vitamin D blood levels prevent sunburn! Of course, it makes sense. When vitamin D levels are low, the skin stays as white as it can to make as much vitamin D as it can, just in case you ignore Dr. Gilchrest's advice. When vitamin D levels are high, the skin rapidly tans to prevent excessive vitamin D skin production. A number of people have emailed me that observation: now that their levels are high, they tan very quickly. I've noticed the same thing. Dr. Marie Demay presented her basic science research that vitamin D is involved in hair follicles. I loved her talk although she's a scientist and I'm a psychiatrist so I didn't understand much of what she said. However, I've always thought that vitamin D will really take off once science shows it's involved in any of three things: sex, athletic performance, or hair growth. In Victoria, we saw evidence for neuromuscular (athletic) performance and hair growth. Two out of three isn't bad; great job, Dr. Demay! In the way of full disclosure, my semi-baldness has not improved on vitamin D, but it has stopped getting worse. Dr. Cedric Garland recounted how, 26 years ago, he and his brother Frank first thought about the relationship between vitamin D and colon cancer. The brothers, together with colleague Ed Gorham, were the first to provide epidemiological evidence that vitamin D deficiency is involved in numerous cancers. Their seminal 1980 paper is going to be reprinted, a well-deserved honor.
Dr. Thadhani and his group from Harvard reviewed their recent discovery that calcitriol and similar drugs increase survival in patients with renal failure. He also presented evidence that renal failure patients have profound deficiencies of both calcitriol and vitamin D and their vitamin D deficiency is not corrected by giving calcitriol or its analogs, which is the current practice. Of course, Dr. Robert Modlin stole the show when he reported on his research just published in Science that vitamin D may be, in effect, a powerful antibiotic. For the first time, the UCLA group showed that when researchers add vitamin D to African American blood, their blood makes more of the natural antibiotics that humans rely on the fight infection. Dr. Adrian Martineau, from the Imperial College in London, followed Modlin and showed vitamin D helped fight tuberculosis, probably from increasing these same natural antibiotics. Science has discovered more than 200 of these naturally occurring antimicrobial peptides; they are especially prevalent in the upper and lower respiratory tract; at least one inactivates the influenza virus. Let's not forget that two other groups have also recently shown the antibiotic potential of vitamin D. Two hundred and sixteen papers were relegated to poster presentations and all 216 of these scientists thought they should have been chosen to present, as did I. Of course, that would have meant a month-long conference. I only have space to mention of few of the most interesting. Dr. Lu presented evidence that the vitamin D content of fish is much less than previously thought, including mackerel. Salmon is OK but the vitamin D almost disappears when the salmon is fried. Dr. Kimball presented a case series of 12 patients with multiple sclerosis who are now on 40,000 units vitamin D a day with an average blood level of 180 ng/ml (the highest is about 400 ng/ml) and they have no evidence of toxicity or calcium disturbances!!! (Don't do this on your own; they have a very serious illness, doses were gradually increased, and the patients are being monitored closely.) Dr. Hardin, from Columbia University, presented evidence that blood levels above 50 ng/ml should help patients with lupus. A group from the University of Manchester presented the mechanism by which vitamin D should reduce arteriosclerosis. A group from the University of Chicago presented evidence that vitamin D should not only prevent colon cancer, but help treat it as well. Dr. Robert Scragg of the University of Auckland presented evidence that ethnic differences in vitamin D levels explain a significant proportion of the reason African Americans are more hypertensive than whites. The group from San
Diego presented evidence that vitamin D deficiency is intimately involved in breast, colon, and ovarian cancer. A group from the University of Manitoba presented evidence that one-month-old infants tolerate 2,000 units of vitamin a day for three months quite well without any evidence of adverse effects. A group from Wake Forest University demonstrated that higher vitamin D levels were associated with better neuromuscular (athletic) performance in older Americans (should help younger Americans too). A group from the University of Amsterdam showed that the increased risk of falling from vitamin D deficiency is much worse in people with a common genetic variation of the vitamin D receptor. Dr. Chen presented evidence that plain old vitamin D should prevent prostate cancer. Dr. Barsony, of Georgetown University, presented evidence that low blood sodium is a risk factor for vitamin D deficiency and that such deficiencies may not be able to be corrected until the low blood sodium is corrected. Dr. Barsony really thought outside the box to discover this potentially very important clinical finding. Dr. Godar presented evidence that young Americans, not just older Americans, are not getting much vitamin D from sunlight. Dr. Taylor showed evidence that a significant number of young children have a previously undetected form of vitamin D in their blood. (Sunlight triggers the creation of a number of different versions of vitamin D in the skin, that's why it's risky to avoid the sun and only depend on oral vitamin D.) Dr. Patel and a group from the University of Manchester announced evidence that vitamin D deficiency may be involved in inflammatory polyarthritis. Dr. Grant was involved in six presentations; the most interesting was his replication of a 1937 finding that squamous cell skin cancer reduces one's risk for a number of internal cancers. That's why I used to be so happy when my dermatologist found a squamous cell cancer on my skin. However, now that I maintain my level at about 60 ng/ml, he hasn't been able to find any new ones. Peller S, Stephenson CS. Skin irritation and cancer in the United states Navy. Am J Med Sci: 1937;194:326-333. Dr. Bulmer and his group from the Royal Victoria Infirmatory produced evidence that vitamin D may play a role in allowing fertilized ova to implant in the uterus and thus enhance fertility. Dr. Reichrath presented evidence that transplant recipients are at a high risk for vitamin D deficiency and that 50,000 units once a month may be the most practical way of ensuring sufficiency. Dr. Selby from the University of Manchester found the same problem in patients with chronic pancreatitis. A group from the University of Tennessee found the same problem in African Americans with heart failure. A group from Norway confirmed that cancer patients do better if they are diagnosed when vitamin D levels are the highest.
Finally, the Australian group headed by Dr. Darryl Eyles and Dr. John McGrath continue to present their convincing evidence (confirmed at this meeting by Dr. Abreu and a group from France) that profound maternal vitamin D deficiency in mammals causes permanent brain damage in their offspring. The racial implication of their work is overwhelming because most of the women in the USA who are profoundly deficient are African American. Are African Americans more likely to be born brain damaged than whites? Would pennies worth of vitamin D improve the disparate prenatal, perinatal, and postnatal outcome in African Americans? The sad fact is that McGrath's and Eyles' work will continue to be ignored because our society has no way to rationally discuss, assimilate, or act on such racially charged scientific discoveries. So, Philip, to answer your question, I don't think you are vitamin D toxic. Your physician just hasn't been keeping up with the literature. When he told you that you might be toxic your mind took over and caused the nausea - much like it does when you eat a contaminated hamburger, get food poisoning, become violently ill, and then become nauseous at the sight of a perfectly good hamburger for the rest of your life. That's my psychiatric explanation (which makes sense from an evolutionary viewpoint as well). Nevertheless, you should ask your doctor for a 25(OH)D level. As far as your semen question, you are really asking if a powerful steroid hormone could have an effect on male ejaculation. Actually two other men have reported the same thing to me in emails. If so, it's the seminal discovery about vitamin D. Most men could care less about vitamin D preventing cancer, heart disease, arthritis, or fetal brain damage. However, if it increases the volume of their semen . . . . John Cannell, MD 9100 San Gregorio Road Atascadero, CA 93422 This is a periodic newsl, a non-profit trying to end the epidemic of vitamin D deficiency. If you don't want to get the newsletter, please hit reply and let us know. This newsletter is not copyrighted. Please reproduce it and post it on Internet sites. Remember, we are a non-profit and rely on donations to publish our newsletter and maintain our website. Send your tax-deductible contributions to: The Vitamin D Council 9100 San Gregorio Road
INSTRUCTION SHEET: ERECTILE DYSFUNCTION (ED) The Student Health Provider has diagnosed erectile dysfunction. What is erectile dysfunction? Erectile dysfunction is when a man can't get an erection to have sex or can't keep an erection long enough to finish having sex. (It used to be called impotence). Erectile dysfunction can occur at age, but it is more common in men older than 75 yea
LESSON PLAN: Polite requests TIME: 55 minutes FOCUS: Polite Requests LEVEL: High Beginner After this lesson students will be able to make polite requests OBJECTIVES MATERIALS ‘Polite Requests’ worksheet, ‘Sentence Order’ worksheet, ‘Gap fill’ worksheet, ‘Polite Requests Flashcards’ A packet of sweets or a bar of chocolate. LANGUAGE Practice polite