The Vitamin D Cure Blog

Vitamin D plays an important role in the formation, function, and protection of the nervous system. Extremely low vitamin D levels are associated with depressed mood, chronic pain from osteomalacia, lower seizure thresholds, and dementia. In the September blog we present more observational data from large cohorts confirming some of these relationships.

It is important to understand the take home message of The Vitamin D Cure (last chapter). Vitamin D is not the answer to all health problems. It is a reflection of an unhealthy lifestyle. The book addresses this lifestyle by focusing on increased sun exposure, supplementation of vitamin D and some other targeted nutrients, dramatic dietary changes, and daily exercise to optimize vitamin D function and lower the risk of all the diseases associated with its deficiency. I cannot emphasize enough, the importance of embracing the entire package of change.

When I wake up at 6 am I do a 30 minute workout. This includes 15 pull ups (whole body), therapeutic band upper body work out, 40 pushups, 100 balance-extension lunges on each leg, recumbent air cycling with leg weights, 40 sit ups, 40 back ups (back extensions lying face down), and stretches. I drink a small pot of Japanese green tea, and then it’s off to work. NO breakfast or lunch 4 days a week. I work straight through the day with no breaks. I drink 2-3 glasses of water through the day. Three days a week I come home from the office and change into my running gear and run 2-3 miles. After my run I have a large meal of lean animal/marine protein and lots of green veggies. Typically I have 1-2 glasses of wine with this and 2 glasses of water. I take my supplements with this meal. My supplements include vitamin D, omega 3, magnesium, niacin, and probiotics.

My grandfather had dementia late in life. My grandmother died at 67 from a heart attack and my father has cardiovascular disease with only a low HDL as a risk factor. I am creating a lifestyle that I believe will prevent the outcomes I see in my family. I am sharing my personal lifestyle with the public because I think that all of us can benefit from these changes. I celebrated my birthday last month and I hope to celebrate many more, without cardiovascular disease and with a brain that works as it was designed to. I offer you the same lifestyle in The Vitamin D Cure.

Recipe of the Month
Remember our recipes are courtesy of Chef Kelly (kellychez@gmail.com). If you have recipes you would like to share or convert to follow the rules of The Vitamin D Cure send them to contact@thevitamindcure.com .

Salmon Citrus Salad

Serves 4

12 ounce salmon fillet with skin
1/4 tsp. salt
1/8 tsp. pepper
1 Tbsp. lemon juice
2 cups canned chickpeas
2 cups halved cherry tomatoes
3 cups sliced cucumber
1/2 cup thinly sliced scallions
2 T. chopped basil
1/4 cup orange juice
3 tbs. white wine vinegar
1/4 cup canola oil
2 tsp. brown sugar or a tablespoon of local honey
1 tsp. dijon
1 tsp. fresh orange zest
1 clove garlic, minced
salt and pepper
4 cups mixed greens (collards, kale, spinach and/or romaine)

Preheat broiler. Place salmon skin-side down on a nonstick broiler pan. Sprinkle with pepper. Place 4 inches from heat and broil 6-8 or until fish just flakes when tested with a fork. Drizzle lemon juice over salmon.

Meanwhile, combine beans, tomatoes, cucumber, scallions, basil and dressing in a large bowl; toss to coat.

Combine orange juice through garlic in a jar and shake until combined; season with salt and pepper to taste.

Next, cut salmon into 1-inch chunks and add to the bowl; toss gently to combine.

Transfer mixture to 4 individual plates, placing on top of mixed greens.

Vitamin D in the News

Serum vitamin D and the risk of Parkinson disease. Arch Neurol. 2010 Jul;67(7):808-11.

This study was based on the Mini-Finland Health Survey, which was conducted from 1978 to 1980, with Parkinson disease occurrence follow-up through the end of 2007. During the 29-year follow-up period, 50 Parkinson disease cases occurred. Serum 25-hydroxyvitamin D level was determined from frozen samples stored at baseline. 3173 men and women, aged 50 to 79 years and free of Parkinson disease at baseline were included. RESULTS: There was a 67% reduction in risk for Parkinson disease with the highest vitamin D levels compared to the lowest after adjustment for sex, age, marital status, education, alcohol consumption, leisure-time physical activity, smoking, body mass index, and month of blood draw (≤ 11.2 ng/mL vs. ≥22.8 ng/mL in men. ≤10 ng/mL vs. ≥20 ng/mL in women).

Vitamin D and risk of cognitive decline in elderly persons. Arch Intern Med. 2010 Jul 12;170(13):1135-41. Public Health and Epidemiology Group, Peninsula Medical School, University of Exeter, Royal Devon and Exeter Hospital, Exeter EX2 5DW, England.

The InCHIANTI population-based study conducted in Italy between 1998 and 2006 with follow-up assessments every 3 years looked at 858 adults 65 years or older who completed interviews, cognitive assessments, and medical examinations and provided blood samples. Cognitive decline was assessed using the Mini-Mental State Examination (MMSE), and substantial decline was defined as 3 or more points. The Trail-Making Tests A and B were also used. RESULTS: The multivariate adjusted relative risk (95% confidence interval [CI]) of substantial cognitive decline on the MMSE in participants who were severely serum 25(OH)D deficient (levels <25 nmol/L) in comparison with those with sufficient levels of 25(OH)D (>/=75 nmol/L) was 1.60 (95% CI, 1.19-2.00). Multivariate adjusted random-effects models demonstrated that the scores of participants who were severely 25(OH)D deficient declined by an additional 0.3 MMSE points per year more than those with sufficient levels of 25(OH)D. The relative risk for substantial decline on Trail-Making Test B was 1.31 (95% CI, 1.03-1.51) among those who were severely 25(OH)D deficient compared with those with sufficient levels of 25(OH)D. No significant association was observed for Trail-Making Test A. CONCLUSION: Low levels of vitamin D were associated with substantial cognitive decline in the elderly population studied over a 6-year period, which raises important new possibilities for treatment and prevention.

Vitamin D Success Story
Please share your successes at success@thevitamindcure.com or online at Amazon. Your success story has a powerful impact on motivating others to change their lifestyle.

The Vitamin D Cure will soon appear in the Korean language published by William Books. The book will be marketed to Korean physicians.

See an interview with Dr. Dowd by the Detroit Free Press at

Easter is a Lunar Holiday or Moveable Feast. It falls on the Sunday after the first full moon of spring. Yes our lives and celebrations are still tied to this SOLAR system.

I have had recurring questions about vitamin D2 and D3, so I thought I would repeat an old commentary from past blogs, D2 or not D2? that is the question. (See below).

I will be delivering two lectures at the American Psychiatric Association of Alaska annual meeting in Girdwood, Alaska. In these lectures I will discuss the relationship between vitamin D deficiency and Schizophrenia, Depression, Multiple Sclerosis, and Dementia. Schizophrenia was a topic that was edited from the book. There is no question Alaskans need more vitamin D. The lectures should generate lots of discussion.

Recipe of the Month
Remember our recipes are courtesy of Chef Kelly (kellychez@gmail.com). If you have recipes you would like to share or convert to follow the rules of The Vitamin D Cure send them to contact@thevitamindcure.com .

Spinach, White Bean & Avocado Salad with White Balsamic Vinaigrette

Ingredients:
-1 T. olive oil
-8 ounces mushrooms, sliced
-2 cloves garlic, sliced
-5 ounces spinach, chiffonade (cut into thin strips)
-15 oz. can Northern White Beans
-1/4 cup minced red onion
-1/4 cup pistachios, toasted and chopped
-1 avocado, cubed
-2 T. White balsamic vinegar
-1 t. Dijon
-1 t. honey
-1/4 cup olive oil
-Salt & Pepper

Directions:
-Saute the mushrooms in 1 T. olive oil until golden brown; add the sliced garlic and continue cooking until golden and crisp. Remove from heat and cool slightly.
-Add spinach to the pan and toss gently.
-In a medium bowl, whisk together the vinegar, Dijon, honey and olive oil; season with salt and pepper to taste.
-To the bowl add 1 can of northern white beans, the red onion, pistachios and the spinach-mushroom mixture. Toss to coat thoroughly.
-Lastly, add avocado and stir very gently so as to not mash the avocado. Chill until ready to eat or serve at room temperature.

For pure Paleolithic skip the white beans and have the salad with grilled salmon or chicken.

Vitamin D in the News: What should I take D2 or D3?

There are two forms of vitamin D you can purchase as supplements, vitamin D2 (ergocalciferol, Drisdol the RX form of D) and D3 (cholecalciferol, no RX version paid for by insurance). D2 comes from plants. D3 is made by mammals from cholesterol with the assistance of UVB radiation and heat. The biological half life of D2 in humans has been determined to be about 3-5 days with complete elimination occurring in 1-2 weeks. The biological half life of D3 as determined by submarine mariners is about 10 weeks. There have been no studies looking at how long it takes to deplete a human to zero D3, although I have seen such patients. The decay of vitamin D or conversion to an inactive form is not a linear process so vitamin D does not follow normal pharmacokinetics.

Normal pharmacokinetics state that in 4 half-lives you reach steady state at a given dose or you reach near complete elimination in the absence of drug. Vitamin D2 would have to be dosed about every 3 days for there to be any sort of steady state because of its very short half life in humans. This is why patients replaced with vitamin D2 once a week or less frequently sees variable increases in their vitamin D levels. In general weekly or monthly dosing of D2 will not produce significant rises in vitamin D levels or vitamin D effect. A recent meta-analysis on the effects of vitamin D on bone confirms the inefficacy of vitamin D as it is commonly prescribed. Vitamin D2 to be effective must be dosed about every 3 days. Unfortunately, there is only one dose of D2 readily available and that is 50,000 IU. That is like trying to do eye surgery with a screw driver and hammer. It is the wrong tool for the job.

Vitamin D3 replacement at a given dose will reach steady state in 10 weeks the same as its half-life in submariners. The long half life of vitamin D3 allows for missed doses without a tremendous drop in blood level. It allows for make up doses and weekly or monthly dosing while still maintaining a steady blood level. Moreover, vitamin D3 is available over the counter at very low cost. Carlson Labs is a reputable manufacturer in business since the mid 1970s. A year’s supply of vitamin D3 gel caps by Carlson Labs or Ddrops from Canada costs about 20 dollars. The co pay for a Drisdol (D2) prescription is likely to be as much for every month’s supply. So for prescription vitamin D2 (those little green gel caps) you end up paying 10 times as much for 3-5 times less effective vitamin D based on weekly dosing. You can get vitamin D at many online retailers for very low cost including shipping. Even Costco and Walmart sell 2000 IU vitamin D3 gel caps.

So we have reviewed, pharmacokinetics, efficacy, convenience, and cost all coming down on the side of D3. The final issue is blood testing. Vitamin D2 is only reliably detectable by two current methods of measurement, HPLC dual mass spec and the Diasorin immunoassay. Mayo Clinic performs the mass spec technique with reliable precision but the precision and reliability of other labs performing this technique is variable. (see my blog Vitamin D Testing Errors Continue) If you test your blood using a method that does not reliably detect D2, and your are taking D2, then you are not going to see a rise in your D level and this could be dangerous. LabCorp uses the Diasorin method to measure vitamin D capturing both D2 and D3 as a single total value. If you are not taking vitamin D2 then there is no concern over the D2 measurement issue only the accuracy of testing.

I hope this clears up all the confusion about D2 and D3. Happy supplementation.

Vitamin D Success Story
Please share your successes at success@thevitamindcure.com OR online at Amazon. Your success story has a powerful impact on motivating others to change their lifestyle.

Many of you have been posting your stories on Amazon. I will simply refer the readers of this newsletter to the latest reviews on Amazon. The stories are fantastic! Keep them coming. REMEMBER YOUR STORY CAN CHANGE LIVES….SAVE LIVES.

Happy Holidays and Welcome to the Vitamin D Blog/Newsletter! I will attempt to keep you up on what I feel to be the most interesting vitamin D research. I have a very busy clinic in adult and pediatric rheumatology at The Arthritis Institute of Michigan in Brighton, Michigan, so my time available to post new blogs is limited to once a week. My interests in medicine extend far beyond vitamin D and I hope to share some of that with you in future books. I also supply blog information to eVitamins.com. I receive no compensation from them, only exposure.

Recipe of the Month
Remember our recipes are courtesy of Chef Kelly (kellychez@gmail.com). If you have recipes you would like to share or convert to follow the rules of The Vitamin D Cure send them to contact@thevitamindcure.com . This week I asked her for a dessert recipe. It still complies with our Paleolithic principles. So, enjoy a little something sweet for the holidays.

Pear Berry Cinnamon Nut Crisp
Fruit filling
5 to 6 cups sliced pears–peeled, (2.5 to 3 pounds)
1 to 2 cups berries of your choice, fresh or frozen
1 to 2 tablespoons fresh lemon juice
1 T. ground flaxseed
1 to 2 tablespoons sugar
Crisp Topping
¾ cup chopped nuts of your choice
¼ cup ground flaxseed
¼ teaspoon salt
2 tablespoons brown sugar
¼ teaspoon cinnamon
2 to 3 tablespoons canola or vegetable oil
Directions
Preheat the oven to 400*F

Place the fruit in a medium-sized bowl, and toss with the lemon juice. Sprinkle in the flaxseed and sugar and toss until evenly coated, then transfer the mixture to an ungreased 9- or 10-inch pie pan. Don’t clean the bowl.

Use the same bowl to make the crisp topping. Combine the dry ingredients; use your fingers, if necessary, to mix in the brown sugar. Add the oil and mix with a fork and/or your hands until uniformly moistened. Carefully crumble the topping mixture over the fruit, and pat it into place. Place the pan on a baking tray, and bake in the center of the oven for 20 minutes, or until brown on top. Cool for at least 15 minutes before serving. Serve hot, warm, or at room temperature.
Serves: 4 to 6
Prep Time: 20 minutes
Cook Time: 20 minutes to bake

Vitamin D in the News
This week past there was a series of articles published in the International Journal of Endocrinology. This article was most interesting to me. This journal is open access, so you can read the full text of these papers. There are some good reviews of information we discuss in The Vitamin D Cure.

Vitamin d levels and lipid response to atorvastatin.
Int J Endocrinol. 2010;2010:320721. Epub 2009 Aug 19.
Department Internal Medicine, Rio Hortega Universitary Hospital, C/ Dulzaina 2,
University of Valladolid, 47012 Valladolid, Spain.

Objectives: Adequate vitamin D levels are necessary for good vascular health. 1,25-dihydroxycholecalciferol activates CYP3A4, an enzyme of the cytochrome P450 system, which metabolizes atorvastatin to its main metabolites. The objective of this study was to evaluate the response of cholesterol and triglycerides to atorvastatin according to vitamin D levels. Design and Methods: Sixty-three patients with acute myocardial infarction treated with low and high doses of atorvastatin were included. Levels of total cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol were measured at baseline and at 12 months of follow-up. Baseline levels of 25-hydroxyvitamin D (25-OHD) were classified as deficient (<30 nmol/L),insufficient (30-50 nmol/L), and normal (>50 nmol/L). Results: In patients with 25-OHD <30nmol/L, there were no significant changes in levels of total cholesterol (173 +/-47 mg/dL versus 164 +/- 51 mg/dL), triglycerides (151 +/- 49 mg/dL versus 177 +/-94 mg/dL), and LDL cholesterol (111 +/- 48 mg/dL versus 92 45 +/- mg/dL); hereas patients with insufficient (30-50 nmol/L) and normal vitamin D (>50 nmol/L) had a good response to atorvastatin. Conclusions: We suggest that vitamin D concentrations >30nmol/L may be required for atorvastatin to reduce lipid levels in patients with acute myocardial infarction.

Comment: In short “Statins” (Lipitor, Zocor, etc…) appear to require a minimum amount of vitamin D (25(OH)D3) substrate (>12 ng/mL or 30 nmol/L) to produce their lipid lowering effects. And, this effect was dose dependent with more dramatic lipid lowering effects at vitamin D levels above 20 ng/mL or 50 nmol/L. More interesting than their lipid lowering effects is their effect on inflammation. We now know that coronary heart disease is an inflammatory disease. Vitamin D is essential for a normal and controlled inflammatory response. We also know that low levels of vitamin D are associated with increased cardiovascular mortality and all cause mortality. Does vitamin D deficiency impair the anti-inflammatory response to statins as well?

Quality of diet and potential renal acid load as risk factors for reduced bone
density in elderly women.
Bone. 2009 Dec 11.
Area di Geriatria, Università Campus Biomedico. Roma, Italy; Fondazione Alberto
Sordi Onlus. Roma, Italy.

BACKGROUND: Bone mineral density (BMD) may be influenced by the general dietary pattern and the potential renal acid load (PRAL). METHODS: We compared the
dietary intake (estimated using the European Prospective Investigation into Cancer and nutrition questionnaire) of 497 community-living women (60 years of age and older) grouped according to tertiles of baseline total, trabecular and cortical BMD estimated using tibial peripheral quantitative computed tomography (pQCT), and of BMD variation over 6 years. RESULTS: None of the other nutrients taken into account nor PRAL was associated with total BMD, with the exception that the intake of polyunsaturated fatty acids (PUFA) was slightly higher among women with the highest total BMD. Similar results were found for trabecular BMD. Cortical BMD was associated with serum 25-OH vitamin D (38.8, 43.2, and 49.5nmol/L in the first, second, and third tertiles, respectively; P=0.042). In the longitudinal analysis, a lower BMI was associated with greater loss of total BMD, while lower serum 25-OH vitamin D at baseline was associated with smaller loss of cortical BMD. CONCLUSIONS: We found no relationship between dietary acid load and BMD. We also confirmed the role of well-recognized risk factor for osteoporosis.

Comment: This study confirms the association between vitamin D levels and both cortical and trabecular bone over time. The higher the vitamin D level was between 15 and 25 ng/mL, the higher the bone mass. This study also confirms the bone protective effect of polyunsaturated fats in the diet that is well described in animal studies. In other words, omega-3 fats make for stronger bones. There was no relationship between dietary acidosis and bone mass. This contradicts previous epidemiological data.

Vitamin D Success Story
Please share your successes at success@thevitamindcure.com or online at Amazon. Your success story has a powerful impact on motivating others to change their lifestyle.

Dear Doctor Dowd:

Thank you for your response! … My rheumatologist gave me no hope and told me the only thing I could do to keep down the inflammation is to take Tylenol or ibuprofen around the clock for the rest of my life (and have my kidneys checked yearly). If I had a flare-up, they would give me colchicine or if it got really bad, a cortisone shot. I showed her your book and one of the case studies that sounded exactly like me and she pooh-poohed it. I had worried about ending up like my grandmother who had rheumatoid arthritis and was almost totally crippled from it.

I’ve since visited a naturopath, and–against my endocrinologist’s and regular doctor’s advice–have begun taking 5,000 IU of vitamin D. My D3 level was 28 at that time. A re-test after 1.5 months showed I had improved to 46, and for the first time in years my C-reactive protein was normal–NOT high…

My knees feel better since I got a cortisone shot and had them drained (20 ccs each) in August. The shot has worn off and some pain returned, but not to the previous levels, and no noticeable swelling. I notice less swelling in my fingers, too, and am totally off ibuprofen.

By the way, our UV level is 1 today, even though it’s clear and bright (not raining!) in Seattle.

Thanks, again.

Susan

HAPPY NEW YEAR!

Last week saw the publication of another study associating heart attacks with very low vitamin D levels this time in men. Dr. Giovannucci analyzed the Health Professions Cohort followed at Harvard University and found that men with vitamin D levels below 15 ng/mL had twice as many heart attacks as men with vitamin D levels above 30 ng/mL. Similar data were published in January from the Framingham Offspring Cohort.

Vitamin D deficiency has also been associated with an increased risk for high blood pressure and heart failure. And, both of these medical conditions lead to an enlarged heart. Enlarged hearts are more susceptible to rhythm disturbances like atrial fibrillation and ventricular tachycardia.

The National Health and Nutrition Examination Surveys from the CDC tell us that Americans only get about half their required potassium intake and only 60 percent of their magnesium intake on a daily basis. These nutrients come primarily from vegetable matter and fruit. Green vegetables have the highest concentration of available magnesium. Americans on average consume less than one serving of green vegetables a day and rarely more than two servings of produce a day.

The Honolulu Heart Study showed a 50-80 percent higher risk for coronary heart disease with lower magnesium intakes. Low levels of potassium and magnesium in the blood increase the risk of rhythm disturbances like atrial fibrillation and ventricular tachycardia particularly following heart bypass or heart attack, thus increasing the risk for sudden death. Low intakes of omega-3 fatty acids particularly DHA and EPA are associated with a higher risk for coronary heart disease and a higher risk for rhythm disturbances in the heart and sudden death.

Tim Russert’s sudden death from coronary heart disease is not a mystery. It was the result of lifestyle factors that too many Americans share. Unfortunately, too many of them will suffer the same fate.

None of this has to happen. Make this news event a wake up call for you to intervene and change the path you’re on. We need to consume at least 6 servings of vegetable matter a day. Two or fewer of these servings should be fruit and two or more of these servings should be green vegetables. We need to increase our consumption of fish and wild free range meats or supplement omega 3 fats. We need to get more exercise and sun exposure. We should check our vitamin D levels along with our cholesterol profiles and supplement vitamin D if needed.

You CAN change the trajectory you are on by embracing the messages in The Vitamin D Cure and convert sudden death into sudden life