The Vitamin D Cure Blog

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!

When the leaves change colors the availability of ultraviolet light to make vitamin D (UVB) disappears till next spring. Your vitamin D level then begins to fall along with all the leaves on the deciduous trees. Ten weeks after peak fall colors your vitamin D level is about half what it was at the end of summer. For me hear in Michigan (42° N) that is about Christmas time or New Year’s. For those of you who live in the southern part of the United States or below 35° N your vitamin D may never fall by half because your winter is not 10 weeks long. The only sources of vitamin D during winter are fat stores and supplements.

Mother Nature intended for us to burn most of our fat stores over the winter due to less food availability. Our Western lifestyles have us typically eating more food through the end of year holidays. So rather than liberating stored vitamin D by burning fat, we are increasing fat volume and retaining vitamin D in fat. If there were ever an appropriate use of fasting it would be from Thanksgiving through Easter. We should eat less in these winter months not more.

Moderate to intense physical activity also stimulates fat burning and will liberate vitamin D from fat stores. Maintaining a routine of this type of activity has been shown in CDC data to translate into significantly higher vitamin D levels. So follow the diet in the Vitamin D Cure year round and establish a daily routine of moderate physical activity.

Remember low vitamin D levels in the winter depress your mood and your immune system. So beat those winter blues and stop all those flu viruses with 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 .

Broiled Spiced Salmon with Roasted Winter Squash & Fennel
Serves 4

For the vegetables:
• 1-1 ½ pound butternut squash, peeled, halved lengthwise, seeded, halved crosswise, then cut lengthwise into 3/4-inch-wide wedges
• 1 fennel bulb, trimmed, cut lengthwise into 1-inch-wide wedges
• 1 large onion, root end left intact, then cut lengthwise into 1/2-inch-wide wedges
• 3 tablespoons olive oil
• 1 teaspoon ground cumin
• 1 teaspoon ground cinnamon
• 1 teaspoon chili powder
• 1/2 teaspoon turmeric

For the Salmon:
• 4 Salmon fillets (4-6 oz. each)
• 1 Tbsp. reserved spice mixture from vegetables
• Salt & Pepper
• Olive oil

1. Position rack in bottom third of oven and preheat to 450°F.
2. Combine squash, fennel, and onion on heavy large rimmed baking sheet. Add oil and toss to coat. Mix all spices in small bowl to blend, reserve 1 Tbsp. for Salmon. Sprinkle spice mixture over vegetables and toss to coat. Sprinkle with salt and generous amount of pepper.
3. Roast until vegetables are tender and browned, turning once, about 45 minutes. Turn oven to broil.
4. For the salmon, foil line and spray a broil pan with nonstick spray.
5. Place salmon fillets on pan and drizzle with oil, season with salt and pepper and evenly sprinkle 4 fillets with reserved spice mixture.
6. Broil for 5 to 7 minutes or until fish flakes easily.
7. Serve over top roasted vegetables.

Vitamin D in the News

Vitamin D has profound and multiple effects on the immune system. This is particularly true when it comes to your response to infections. We know how it affects our response to tuberculosis. The effects of vitamin D on our response to viruses like the flu are a bit less clear. Here is an excellent review of the data that is our there.

Vitamin D for treatment and prevention of infectious diseases: a systematic review of randomized controlled trials. Endocr Pract. 2009 Jul-Aug;15(5):438-49.
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30030, USA.
OBJECTIVE: To review the existing human controlled intervention studies of vitamin D as adjunctive therapy in settings of infection and provide recommendations for design and implementation of future studies in this field on the basis of the evidence reviewed. METHODS: We conducted a systematic review of randomized controlled clinical trials that studied vitamin D for treatment or prevention of infectious diseases in humans. Studies from 1948 through 2009 were identified through search terms in PubMed and Ovid MEDLINE. RESULTS: Thirteen published controlled trials were identified by our search criteria. Ten trials were placebo controlled, and 9 of the 10 were conducted in a rigorous double-blind design. The selected clinical trials demonstrated substantial heterogeneity in baseline patient demographics, sample size, and vitamin D intervention strategies. Serious adverse events attributable to vitamin D supplementation were rare across all studies. On the basis of studies reviewed to date, the strongest evidence supports further research into adjunctive vitamin D therapy for tuberculosis, influenza, and viral upper respiratory tract illnesses. In the selected studies, certain aspects of study design are highlighted to help guide future clinical research in the field. CONCLUSION: More rigorously designed clinical trials are needed for further evaluation of the relationship between vitamin D status and the immune response to infection as well as for delineation of necessary changes in clinical practice and medical care of patients with
Vitamin D deficiency in infectious disease settings.

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.

Hi,
I am a Registered Nurse working in the City of London. As I live in rural Essex, I commute daily in to London. Reading my newspaper on the train a few weeks ago I came across an article on Vit. D. This seemed interesting so I ordered Dr. Dowd’s book.

On reading this book I realized that I ticked all the boxes of symptoms being Vitamin D deficient. I have weak muscles/aches/not much strength, and always struggle when I went to a Gym. I was diagnosed with Fibromyalgia around 10 years ago, which settled but I always feel fatigued etc… I lead a very busy life working full time in London as a Registered Nurse. You wouldn’t know that I have discomfort as I just get on with it.

A colleague took some blood and my level of Vit. D was 31 nmol/L range from out lab is 75 - 200 nmol/L. Magnesium level is 0.84 range from our lab is 0.65 - 1.05. I put myself on ‘Life Extention’ 1000iu x 2 daily from Victoria Health and Magnesium. I am trying to change my diet which was mostly vegetarian.

By the way I am Scottish….so not much sun in my life when I was growing up. I am going to keep to this regime and will let you know the outcome. So glad I came across the article and the book which will be useful for my colleagues and patients. I have ordered a couple of copies of the book to give to a couple of my doctor colleagues.

Regards,
Lorna.

Vitamin D production requires ultraviolet B spectrum light (280-315 nm wavelength). Cholesterol from our diet and that produced in our liver is modified then transported to the skin where it is stereochemically altered by UVB light and heat, returned to the liver and further modified to 25-hydroxy cholecalciferol (D3). This is the molecule we measure in our blood.

The shortest day of the year marks the winter solstice which falls on December 21st of a solar calendar year. This year the sun is furthest from North America at 12:04 pm on December 21st. Most cultures celebrate the solstice between December 24th and January first. These celebrations often mark the birth of the new solar cycle. They often signify the beginning of true winter (the coldest part of the year).

Not only are we further from the sun at this point in the year but the angle of the sun from the horizon is more acute or smaller. In the case of Michigan this angle is less than 25 degrees from horizontal. We see this as the sun crossing the sky very close to the horizon through the course of the day.

At this sharp angle the path of the suns rays must travel through more ozone to reach the earth’s surface. Subsequently, no UVB reaches the earth’s surface. Cloud cover and smog can also reduce penetration of ultraviolet light throughout the year, reducing or preventing vitamin D production.

At a winter solstice, solar angle of greater than 35 degrees, without cloud cover, enough UVB reaches the earth’s surface to produce vitamin D even on the shortest day of the year. This occurs at a latitude of about 30 degrees. So if you live in one of these cities or south of these, potential year round sun is available to make D.

Temperature also plays a role in this equation because warmth of the skin is also necessary to facilitate production and allow comfortable exposure of 50 percent or more of the body surface (shorts and T-shirts or less cover). The jet stream affects the temperature at different latitudes and longitudes, as does altitude and the proximity to large bodies of water, humidity, and ground cover. Remember warmth lags behind solar radiation. The warmest time of day is between 3-5 pm, the warmest time of year is about 3-5 weeks after summer solstice. Conversely the coldest time of year is 3-5 weeks past winter solstice.

Suffice it to say that you want to be in a sunny place 30 degrees or less latitude, receiving equatorial winds, near a body of water, with moderate humidity and little cloud cover. These conditions will allow at least fifty percent skin exposure in the afternoon hours of the winter months. Voila, you’re making vitamin D. Remember sunscreen blocks vitamin D production so don’t use it when you are trying to make vitamin D.

Now you have the recipe for finding a winter vacation spot. If you want something to read while you are making vitamin D this winter get The Vitamin D Cure and send us a post card.