When The Leaves are Falling Vitamin D’s are Falling

When the leaves change colors the availability of ultraviolet light (UVB) to make vitamin D disappears till next spring. Your vitamin D level 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.

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. Try fasting one day a week or consider doing a “cleanse” once a month during the winter.

Moderate to intense physical activity also stimulates fat burning and will liberate vitamin D from storage in fat. Routine physical activity that breaks a sweat 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.

Recipe of the Month
Remember our recipes are courtesy of Chef Kelly . Kelly has provided 15 new recipes for the upcoming revised edition of The Vitamin D Cure due out in November 2011. Look for it in bookstores and on Amazon.

This month’s recipe is one of my favorites.

Broiled Spiced Salmon with Roasted Winter Squash & Fennel (replay)
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

The Endocrine Society published their guidelines for vitamin D testing and replacement in July 2011. These recommendations are very different from those of the Institute of Medicine. Let’s take a look at these more reasonable guidelines for screening and replacement.

Here are some key differences between IOM recommendations and Endocrine Society guidelines:

1. Normal vitamin D is ≥ 30 ng/mL or 75 nmol/L and ≤ 100 ng/mL or 250 nmol/L. (IOM – normal vitamin D ≥ 20 ng/mL)
2. Individuals with a variety of medical problems or in high risk groups should have their vitamin D levels measured and brought to normal. African Americans, Latinos, Asians, pregnant women, breast fed infants, and elderly are all among the groups in which measurement should be performed. (IOM – Testing only in patients with bone disease)
3. Recommended vitamin D supplementation amounts are more robust: 400-1000 IU daily for infants, 600-1000 IU daily for children, and 1500-2000 IU daily for adults and pregnant women. Although any size dose required, to maintain a normal level is appropriate. (IOM –400 IU for infants, 600 IU for children and adults, 800 IU for adults over 70)
4. Upper Limit of Safety was raised to 2000 IU for infants, 4000 IU for children and 10,000 IU for adults, (IOM – Upper safety limit 1000-1500 IU for infants, 2500-3000 IU for children and 4000 IU for adults)
5. Vitamin D levels should be measured no more frequently than every 3 months.

These are consistent with the recommendations The Vitamin D Cure presented in 2008. The book recommends weight based dosing rather than flat dosing because it is more accurate and requires less monitoring to reach normal.

The Vitamin D Cure details a complete lifestyle that maximizes vitamin D levels and vitamin D function beyond simple supplementation. Supplementation alone is not enough you need a lifestyle that puts vitamin D to work.

See my mini webpage on the new American Board of Integrative Holistic Medicine website.

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 Dr. Dowd,

You have changed my life and we haven’t even met.

I am almost crying tears of relief as I write this. I have suffered with chronic pain and fatigue for 25 years now. I have tried every supplement and spent over $5000 trying natural treatments and seeing the doctor but nothing has helped. I have had some things that help me for a while but nothing lasts and I always slip back into a pain flare or I am so exhausted I can’t function.

Lately I have been having terrible pain flares again so I have been on the hunt for the solution. The other day I saw your book and when I saw the subtitle about healing my pain I grabbed a copy , raced home and have been reading and implementing it ever since. I have been following a paleo diet for years now and that has brought me a lot of relief but it wasn’t quite enough. It wasn’t the complete picture. Vitamin D was the missing link.

I have been on 8-10,000 I.U. for 4 days now and am having amazing results. My ankle pain is nearly gone; my stiffness is going away; my leg muscles have more strength, coordination and endurance. I am so excited and have so much energy. I was up at 2 am washing laundry and doing dishes. (I will take a nap I promise) I just can’t tell you how grateful I am for your book and for how you have changed my life already.

I am so looking forward to walking and getting rid of the excess weight that I have gained since being Vitamin D deficient. Living in Maine it is no surprise that I am deficient but I am just shocked that no Doctor has ever suggested this to me before. I was even tested last summer and my level was only 32 in August so I know I was low but until reading your book I never realized how important this is for health.

Again, thank you for changing my life

Sincerely, Debbie
Bowdoinham, Maine

The free online version of the IOM report is almost impossible to read using their outdated image technology without printing or purchasing the report. There are many errors and misinterpretations of the data by this committee. The committee was constructed of scientists who have a limited knowledge of vitamin D and certainly have not been the major researchers in the field over the last 40 years. I will lay out the data as I see it and as was detailed in The Vitamin D Cure. This will be organized as errors in the logic of the IOM.

ERROR #1: What is the blood level definition of vitamin D deficiency? This is the primary debate. The IOM has set the lowest normal value and the definition of deficiency at < 20 ng/mL. Their conclusions that North Americans for the most part get enough vitamin D are based on choosing this very low level as normal. The presence of disease and calcium, vitamin D, and bone physiology/anatomy define the lower limit; and it’s not 20 ng/mL. Let’s take a closer look.

The IOM’s primary argument for 20 ng/mL is based on clinical disease measurements (rickets, osteoporosis, bone density). The weakness of using this approach to define the lower limit is the heterogeneous origin of all clinical disease states and the insensitivity of clinical symptoms. All clinical symptoms appear late in the course of disease. The heart attack occurs after 30 years of low grade inflammation and plaque formation from unhealthy living. Even the diagnostic tests we use to identify ‘early’ disease represent late findings. The low bone mass on bone density and the osteoporotic fracture that results occurs after decade(s) of abnormal bone metabolism. This is true of lab tests as well.

Let’s look at rickets. Nutritional rickets is defined as a disease of abnormal bone formation that results from vitamin D deficiency and some element of inadequate protein or calcium intake. Similarly, osteomalacia is abnormal bone formation and structural failure related to these same conditions in adults. The symptoms of these diseases result from months to years in children and years to decades in adults of nutritional deficiency and abnormal bone biology.

What is the level of vitamin D that defines patients with these diagnoses? As it turns out there is no agreed upon threshold of vitamin D deficiency associated with nutritional rickets or osteomalacia. Some studies document vitamin D levels just shy of 35 ng/mL in children WITH clinical rickets; just as you can see children with vitamin D levels less than 10 ng/mL without clinically evident rickets. This is true of all the data for osteomalacia as well. Dietary calcium and protein intakes alter the vitamin D threshold for clinical bone disease. Low dietary calcium and low dietary protein intake make rickets more likely at higher vitamin D levels. However, I do not know of any reports of rickets or osteomalacia at vitamin D levels at or above 35 ng/mL. I wonder why?

A recent breakthrough study looking for changes of osteomalacia in bone biopsies helps us understand the disease beyond these late clinical findings. This study was published in the Journal of Bone and Mineral Research in February 2010 and was misinterpreted when reviewed by the IOM. In this study, 675 iliac crest bone biopsies from autopsies of adult men and women from Northern Europe were studied and correlated with vitamin D levels from the biopsy subjects. In a biopsy the scientists can measure the ratio of non-mineralized bone volume to total bone volume. This ratio is increased above 1.2-2% when there is a mineralization defect, such as from vitamin D deficiency or osteomalacia. They did not find any increase in this ratio in subjects with vitamin D levels above 75 nmol/L or 30 ng/mL whether they chose 1.2% or a more conservative 2% cut off. This study avoids the delayed and subjective nature of disease symptoms and the late findings of x-ray studies and simply correlates bone pathology at the microscopic level with vitamin D levels. This study indisputably argues for an optimal vitamin D level of equal to or more than 30 ng/mL. This study ENDS the debate on defining vitamin D deficiency. The pathologic definition of vitamin D deficiency is a blood level <30 ng/mL.

ERROR #2: The IOM reviewed data on a host of diseases. The bulk of epidemiological data was for bone disease (osteoporosis, rickets). The poor sensitivity and late findings of bone densitometry and fractures artificially lower the vitamin D level at which you see clinical disease. The 30 ng/mL cut off for normal is consistent with several lines of physiological evidence. Vitamin D levels much above 30 ng/mL do not lead to further decline in parathyroid hormone levels.

Vitamin D levels below 30 ng/mL are associated with a fall in the absorption of calcium from the intestine. Maximum fractional absorption of calcium from the diet is about 35% at a vitamin D level at or above 35 ng/mL when all other conditions are normal. Calcium absorption from the gut remains stable up to and beyond vitamin D levels of 100 ng/mL. This fractional absorption drops by half at a vitamin D level of 20 ng/mL. Severe calcium deficiency may increase absorption fraction but only if vitamin D levels are above 30 ng/mL. In other words calcium balance is optimized at vitamin D levels above 30 ng/mL.

ERROR #3: The IOM focuses on clinical diseases for which there is controversial data to argue for a lower cut off. The 30 ng/mL or greater level for optimal health is consistent with all the large epidemiological databases. The incidence of type II diabetes, colon cancer, and all-cause mortality all correlate with this same 30 ng/mL threshold for optimal vitamin D function. Click on the highlighted diseases to see the research studies.
Type II Diabetes
Colon Cancer
Cardiovascular and All-Cause Mortality

ERROR #4: Exercising caution with the supplementation of vitamin D is often justified by comparing it to the failure of studies supplementing vitamin A for cancer prevention and the historic use of estrogens to reduce all-cause mortality in post menopausal women. Let’s look at these two examples.

All the studies looking at vitamin A show that adult Americans not only get adequate vitamin A in their diet but they have normal vitamin A levels in their blood with room to spare. It makes no sense to do a study of supplementation of a nutrient in a population of patients with levels above the lower threshold of normal. You will not see any favorable results. Moreover, Hector DeLuca has shown that vitamin A antagonizes vitamin D function. Vitamin A supplements will further suppress vitamin D metabolism in an already deficient population increasing the risk of malignancy. This is the likely mechanism of increased lung cancer in smokers taking beta-carotene supplements without normalizing vitamin D first.

The second example is estrogen replacement. Estrogen replacement was never a good idea. Think about it. Nature evolves to produce the senescence of ovarian function to protect the woman from the risks of a pregnancy in late adult life and reduce the risk of cancer. Then modern medicine replaces estrogen in post menopausal women thinking it’s the fountain of youth, only to find an increased risk of breast cancer and cardiovascular complications.

Vitamin D replacement is suggested in patients with levels less than 30 ng/mL with a target of 40-65 ng/mL as would be found in wild primates and in life guards and non-mechanized farmers who work in the sun. Nobody is suggesting replacing vitamin D in people with normal levels. Based on data complied by Dr. Reinhold Vieth, there are no credible reports of toxicity in adults with levels under 200 ng/mL. The safety window for vitamin D is seven times greater than the threshold of normal. We are vitamin D deficient because we spend no time outside in the sun unprotected by clothing or sun screen, like our Paleolithic ancestors. Moreover, we do not eat the wild animal protein, wild seafood, and particularly organ meat that we evolved on, which was high in vitamin D.

Vitamin D supplementation is required by most Americans because we are rarely exposed to sun and our diets are filled with grain-based carbohydrates that are devoid of nutrition. Moreover, vitamin D is stored in fat and only liberated with moderate or intense exercise, something that most Americans do not do. Our lifestyle is a perfect storm for vitamin D deficiency.

ERROR #5: The IOM is focusing on deficiency when it should be focusing on optimal health values for vitamin D. The scientific community continues to argue about the lower limit of normal when we now have definitive pathologic data showing that an optimal vitamin D level is at or above 30 ng/mL. Moreover, if no credible toxicity has been reported for vitamin D levels below 200 ng/mL, why are we obsessing over whether our vitamin D level should be 20 ng/mL or 30 ng/mL? This is like arguing over whether your cholesterol should be 220 mg/dL or 200 mg/dL. I personally would like to have a cholesterol of 160 rather than either 220 or 200. Likewise I would rather have a blood pressure in the middle of the normal range not on the cusp of abnormal. Why can’t we focus on what is relevant and design public health recommendations with common sense? I guess common sense rarely comes out of government sponsored committees. Moreover, why wouldn’t you select committee members from the scientists who have been doing the research on vitamin D for the last 50 years.

You decide. I have made up my mind and outlined the logic behind my decision and recommendations; you can read more details in The Vitamin D Cure. Don’t let the government that gave us the food pyramid with three servings of dairy a day and a 55% carbohydrate diet decide your health future. Bureaucrats have a lousy track record at producing good health.

Recipe of the Month

The winter solstice is a celebration of the year’s bounty. I asked Kelly to give us a recipe for something sweet to celebrate. The pork tenderloin provides a contrast to the traditional poultry, ham, and beef roast of the season. The sweet plums, nectarines, and honey are a bright contrast to the herbs of the tenderloin. Buy your ingredients locally and enjoy!

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 .

Roasted Pork Loin with Orange-Herb Sauce & Roasted Baby Carrots
Serves 4

3 Tbsp. Oil
2 garlic cloves, minced
1 ½ lb. boneless pork loin
1 cup orange juice, a local fruit juice can be substituted (preferably fresh)
½ cup chicken stock or broth
½ cup white wine (of your choice)
4 black peppercorns
1 rosemary sprig
1 oregano sprig
1 parsley sprig
2 Tbsp. chopped parsley
1 ½ lbs. (5-inch) long baby carrots, washed & greens cut
1 red onion, peeled, cut into 8 wedges
2 Tbsp. oil
1 Tbsp. fresh rosemary, chopped
Garlic Powder
Salt and Pepper

Pork
In a large bowl combine 2 Tbsp. oil with the garlic and coat pork; let stand for 1 hour.
Preheat oven to 400 degrees F and in a medium skillet (ovenproof) heat the remaining oil.
Season the pork with S & P and add to the skillet, fat side down. Cook over medium high heat until golden brown (approx. 4 minutes.)
Brown all sides and then turn it fat side up.
Add the OJ, stock or broth, wine, peppercorns and herb sprigs; bring to a boil.
Transfer to the top shelf of the oven and roast for about 35 minutes or until the internal temperature is 145 degrees.
Remove from oven and let rest for at least 10 minutes.
Strain the cooking liquid from the pork into a saucepan and boil until reduced to ½ cup, about 15 minutes.
Season and stir in chopped parsley.

Carve the pork and serve with orange sauce and roasted carrots.

Carrots
Gently toss together the carrots, red onion, rosemary to coat with the olive oil.
Lay out on a rimmed baking pan. Sprinkle with garlic powder, salt, and pepper.
Roast for 30 to 40 minutes on middle rack or bottom rack (with pork in the oven too), until well browned.

Honey Roasted Fruit with Streusel Topping
Serves 8

• 4 whole Ripe Nectarines
• 4 whole Ripe Red or Purple Plums
• 2 tsp. Honey
• ¼ cup Old Fashioned Oats
• 2 Tbsp. Brown Sugar or Honey
• ¼ cup chopped nuts (Pecans, Walnuts, anything you like)
• ¼ cup Oat Bran
• 2 Tbsp. Canola Oil
• 2 Tbsp. dried fruit (cranberries, raisins, cherries, chopped dates, etc.)

Lightly grease a 9 x 13-inch pan.
Cut each piece of fruit in half and remove the seed or pit.
In the greased baking dish place the fruit flesh-side up, nestling all the fruit together tightly to fit in the pan.
Drizzle the fruit with about 1-2 teaspoons honey.
Roast fruit for 15 minutes.
Meanwhile make the streusel by combining the oats, honey, chopped nuts, oat bran, dried fruit and canola oil; mix well.
Remove fruit from oven and sprinkle fruit with streusel topping; roast for another 15 minutes until the fruit is hot and tender.
Test the fruit by poking it with a fork to see if it comes out easily.

Vitamin D in the News

This international summary of the public health issue of vitamin D deficiency was put together by scientists and clinicians who have spent the better part of the last forty years researching vitamin D. This differs from the IOM committee which was composed of scientist and clinicians with little or no research exposure to vitamin D. This paper should serve as your guide rather than the IOM report. Enjoy!

Vitamin D Cure 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.

In October I spent a day at Dole Foods headquarters in the Los Angeles area to film an interview promoting the consumption of fruits and vegetables. This video will soon be available on their web site.

In November I was in San Diego for the 11th Annual Science and Clinical Application of Integrative Holistic Medicine sponsored by the American Board of Integrative Holistic Medicine and Scripps Center for Integrative Medicine . It was a terrific opportunity to interact with many like minds at the leading edge of change in the promotion of optimal health rather than the symptom management of disease.

Happy Holidays! And Happy New Year!

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

• Explains how vitamin D works in health and how deficiency causes disease.
• Recommends routine measurement of vitamin D levels for health screening.
• Tables help calculate accurate vitamin D replacement using your weight.
• Provides a single table to estimate safe unprotected sun exposure using the UV index.
• Promotes a Paleolithic diet that balances acid-base by emphasizing adequate lean protein from animals and fish combined with generous vegetable matter. (Tables and worksheets)
• Targets supplementation of vitamin D, omega 3 fats, and magnesium.
• Describes exercises to optimize vitamin D metabolism, weight loss, and quality of life.

The Vitamin D Cure introduces the importance of vitamin D and diet as EPIGENETIC influences on the risk for disease as an older child and adult.

The Vitamin D Cure is the first book that emphasizes the importance of vitamin D and diet in altering the development of our MICROBIOTA. These are the bacteria in our colon that shape our growth and development.

I encourage the reader to explore all the nooks and crannies in this book. Take out your highlighter and mark it up and write in the margins. That’s what paper books are for. You will find that this book is packed with information. The references online are organized by chapter and many are linked to full text through PubMed. Take advantage of these links, they are your tax dollars at work.

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 or post them as comments on the blog.

Mixed Herb Greens with Grilled Chicken, Fresh Raspberries, Pistachios and Balsamic Vinaigrette
Serves 4

4 chicken breasts (about 4 oz. each)
Fresh lemon slices & Pepper
8 cups mixed greens with herbs
1 cup fresh raspberries
1/2 cup pistachios, chopped
1 small red onion, sliced thin
1/4 cup balsamic vinegar
2 garlic clove, minced
1 tsp. Dijon mustard
1 tsp. honey
3/4 cup olive or canola oil

Preheat grill to medium-high heat. Season chicken breasts with fresh squeezed lemon juice and pepper and grill about 4 minutes a side or until juices run clear. Let the chicken rest for 10 minutes then slice.

In a large serving bowl put the mixed greens. Next evenly sprinkle the raspberries, pistachios, and red onion. Top salad with sliced chicken.

In a small food processor place the balsamic vinegar, garlic, Dijon and honey; pulse a few times. With the machine running, slowly drizzle in the olive or canola oil until it has all been incorporated. Season with lemon juice and pepper. Drizzle over salad and serve.

Vitamin D in the News

Is casual exposure to summer sunlight effective at maintaining adequate vitamin D
status? No

A study from the UK shows that current advice about modest sun exposure during the summer months does little in the way of boosting overall 25(OH)D levels. Moreover, they comment that failure to understand the nature of human exposure to sunlight leads to misguided advice concerning the sun exposure necessary for an adequate vitamin D status. See the sun exposure tool on The Vitamin D Cure website to calculate accurate exposure times based on real time UV index data.

Photodermatol Photoimmunol Photomed. 2010 Aug;26(4):172-6.

A study published last month verified this by exposing volunteers to 1.3 erythemal dose of simulated sun apparently only 13 minutes of exposure three times a week during the winter at 53 degrees north latitude. After 6 weeks of this exposure 74% of the volunteers were still deficient. Only 26% of the volunteers had vitamin D levels above 32 ng/mL, which is the cut off for normal.

This tells us that 13 minutes of sun wearing T-shirt and shorts 3 times a week is not enough sun exposure to raise vitamin D levels into the normal range. As we recommend in the Vitamin D Cure, 50% of skin exposure or more is necessary and now more than 3 exposures a week appear to be necessary for sunlight to normalize vitamin D levels in the short summer of the UK. Over exposure becomes a concern with longer times and more frequent exposures. The Vitamin D Cure provides an alternative to struggling for enough sun exposure. Supplementation is an easy and safe way to normalize your vitamin D levels. When combined with dietary and exercise recommendations in the Vitamin D Cure, your vitamin D system is sure to be optimized.

J Invest Dermatol. 2010 May;130(5):1411-8. Epub 2010 Jan 14. Photobiology Unit, Dermatological Sciences, School of Translational Medicine, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Hospital, Manchester, UK.

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.

See my recent interview in the Detroit News.

There will be an exciting conference in Los Angeles in the Summer of 2011, The Ancestral Health Symposium . Loren Cordain calls it the “Woodstock of Evolutionary Medicine”. Brent Pottenger is organizing the program and there should be a potpourri of presentations by many experts, advocates, and practioners. Brent’s wonderful blog will keep you posted as the event approaches.

There is a new book out, Principles of Evolutionary Medicine by Peter Gluckman, one of the world’s leading researchers in this area. I have my copy ordered. The table of contents looks terrific. It should be an intense read. Peter Gluckman and David Barker are members of a generation of evolutionary biologist who have connected the theory with animal and human disease models. There will be some Nobel prizes handed out to some of these scientists.

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 month’s recipe is Gourmet Mushrooms & Sausage over Wild Rice

Serves 4
-1 Tbsp. Olive Oil
-1 larger onion, chopped
-12 ounces Italian Sausage, casings removed (try venison or other wild game sausage)
-1 Tbsp. tomato paste
-1/2 cup parsley, chopped
-1/4 cup cilantro, chopped
-2 cups low sodium chicken or vegetable broth OR stock
-1 10-ounce package frozen spinach
- 2 cups of dried gourmet mushrooms rehydrated in water (Portobello, morels, porcini etc…)
-Salt and pepper
-1 cup wild rice
-1 cup cold water

Directions:
(For the stew)
-Heat oil in a large saucepan over medium heat; add onion and cook until soft (about 5 to 7 minutes.)
-Add sausage and cook, crumbling it until browned.
-Add the tomato paste and cook another 2 minutes. Stir in parsley & cilantro and cook 1 more minute.
-Add the broth and rehydrated mushrooms; bring to a boil. Add the frozen spinach and simmer, partially covered, for 10 minutes. Stir occasionally.
-Stir in salt and pepper to taste.
(For the rice)
-In a saucepan cover rice and water until it comes to a boil. Reduce to low and cook 20 minutes or until the rice is al-dente.

Place rice on the plate and spoon the mushroom and sausage mix over the rice and serve.

Vitamin D in the News

An article came out in JAMA (Journal of the American Medical Association) showing again that single annual high dose vitamin D replacement is not effective at preventing fractures of falls in elderly. This paper published 2007 also showed no benefit to annual dosing.

If you want to effect a change you have to change more than one variable as in the study that came out in Archives of Internal Medicine this month. In this study they replaced vitamin D and had patients participate in physical therapy.

Osteoporosis is NOT a disease of elderly it is a symptom of the elderly; it is a life long disease. Many young girls fail to attain peak bone mass due to poor nutrition (lack of protein and green veggies) and lack of exercise. They then enter late adult life and begin to gradually lose bone mass from a position of weakness. This accelerates after menopause and then they become symptomatic with fractures. It is NOT surprising to see a lack of benefit from relatively short term intervention (1-2 years) of a single variable in a disease influenced by many factors over many decades.

Research by Reinhold Vieth, PhD from University of Toronto showed that monthly dosing of vitamin D produces swings that tended to cause some calcium loss in the urine from high peak levels of D. Weekly and daily dosing did not cause this problem. Moreover, many of the reports of vitamin D toxicity come from Europe where they commonly use IM injections of high dose vitamin D in institutionalized elderly. The absorption of vitamin D from these injections is not consistent from patient to patient. Vitamin D ( 25(OH)D ) in too high of a blood level can induce some over production of the active hormone. High levels of the active hormone will pull calcium out of the bone and increase fracture risk.

Timing is everything. You want normal vitamin D levels during the phase of your life when you are building bone (third trimester of fetal gestation through 20 years of age). This is when it has its greatest benefit to bone. Treating older individuals who have lost bone is not likely to show much difference unless you focus on people with vitamin D levels below 20 and preferably with compensatory hyperparathyroidism; and throw in lots of exercise (stimulus to build bone). The solution is entire Vitamin D Cure program.

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. Check out the latests successes on Amazon.

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.

And this month for the palate, we have a vitamin D rich recipe of Salmon with asparagus and mushrooms. For Valentines Day you might chase this with some dark chocolate and a glass of port. Yuuuumy!

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.

Seared Salmon with Asparagus & Mushrooms

Ingredients:
• 4 Fresh skinless wild salmon fillets (about 1 pound)
• Salt & Pepper
• 2 Tbsp. olive oil
• 2 cups sliced assorted mushrooms (such as button, cremini, shittake)
• 1 cup onion, chopped
• 6 cloves garlic, minced
• 1 Tbsp. fresh thyme, chopped
• 1 cup dry white wine
• 1 cup clam juice, fish stock, chicken stock or broth (whatever you have)
• 2 cups asparagus, cut into 1 1/2 in. long pieces
• 1 cup cherry tomatoes, halved
• 1 Tbsp. fresh parsley, chopped
• 1 tsp. lemon juice

Directions:
• Pat fish dry and season with salt and pepper.
• Heat 1 Tbsp. of olive oil in a large skillet over medium heat. Add the mushrooms and cook until golden brown, about 5 minutes. Add onion, garlic and thyme; cook until mushrooms are tender. Add the wine and bring to a boil; reduce heat and simmer uncovered for 15 minutes or until liquid is reduced to 1/4 cup.
• Add clam juice (or stock) and return to a boil. Reduce heat and simmer for another 15 minutes or until the liquid is reduced to 3/4 cup.
• Add the asparagus and cover; cook for about 3 minutes or until al dente (crisp-tender.) Stir in the tomatoes, parsley and lemon juice. Season with salt and pepper and transfer to a serving platter; keep warm.
• In the same skillet, heat the remaining olive oil over medium-high heat. Add the salmon and cook for 4-6 minutes per 1/2 inch thickness, or until fish flakes easily with a fork, turning once.
• Serve salmon over vegetable mixture and garnish with lemon wedges and fresh thyme.
Makes: 4 Servings

Vitamin D, Diet, and Exercise in the News

Association of marine omega-3 fatty acid levels with telomeric aging in patients with coronary heart disease.
JAMA. 2010 Jan 20;303(3):250-7.
Division of Cardiology, Room 5G1, San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA 94110, USA.

CONTEXT: Increased dietary intake of marine omega-3 fatty acids is associated
with prolonged survival in patients with coronary heart disease. However, the
mechanisms underlying this protective effect are poorly understood. OBJECTIVE: To
investigate the association of omega-3 fatty acid blood levels with temporal changes in telomere length, an emerging marker of biological age. DESIGN, SETTING, AND PARTICIPANTS: 608 ambulatory outpatients in California with stable coronary artery disease recruited from the Heart and Soul Study RESULTS: Individuals in the lowest quartile of DHA+EPA experienced the fastest rate of telomere shortening, whereas those in the highest quartile experienced the slowest rate of telomere shortening (P < .001 for linear trend across quartiles). Levels of DHA+EPA were associated with less telomere shortening before and after sequential adjustment for established risk factors and potential confounders. Each 1-SD increase in DHA+EPA levels was associated with a 32% reduction in the odds of telomere shortening. CONCLUSION: Among this cohort of patients with coronary artery disease, there was an inverse relationship between baseline blood levels of marine omega-3 fatty acids and the rate of telomere shortening over 5 years.

Long-Chain Omega-3 Fatty Acids for Indicated Prevention of Psychotic Disorders:A Randomized, Placebo-Controlled Trial.
Arch Gen Psychiatry. 2010 Feb;67(2):146-54.
Orygen Youth Health Research Centre, 35 Poplar Rd. Vienna, Austria

CONTEXT: The use of antipsychotic medication for the prevention of psychotic disorders is controversial. Long-chain omega-3 polyunsaturated fatty acids (PUFAs) may be beneficial in a range of psychiatric conditions, including schizophrenia. Given that omega-3 PUFAs are generally beneficial to health and without clinically relevant adverse effects, their preventive use in psychosis merits investigation. OBJECTIVE: To determine whether omega-3 PUFAs reduce the rate of progression to first-episode psychotic disorder in adolescents and young adults aged 13 to 25 years with subthreshold psychosis. DESIGN: Randomized, double-blind, placebo-controlled trial conducted between 2004 and 2007. PARTICIPANTS: Eighty-one individuals at ultra-high risk of psychotic disorder. INTERVENTIONS: A 12-week intervention period of 1.2-g/d omega-3 PUFA or placebo was followed by a 40-week monitoring period; the total study period was 12 months. RESULTS: 93.8% completed the intervention. By 12 months, 2 of 41 individuals (4.9%) in the omega-3 group and 11 of 40 (27.5%) in the placebo group had transitioned to psychotic disorder (P = .007). The difference between the groups in the cumulative risk of progression to full-threshold psychosis was 22.6% (95% confidence interval, 4.8-40.4). Omega-3 Polyunsaturated fatty acids also significantly reduced positive symptoms (P = .01), negative symptoms (P = .02), and general symptoms (P = .01) and improved functioning (P = .002) compared with placebo. The incidence of adverse effects did not differ between the treatment groups. CONCLUSIONS: Long-chain omega-3 PUFAs reduce the risk of progression to psychotic disorder and may offer a safe and efficacious strategy for indicated prevention in young people with sub-threshold psychotic states.

COMMENT: Higher omega 3 blood levels in heart patients appear to be associated with slower shortening of telomeres in white blood cells. Remember, the lengths of telomeres are associated with longevity or survival. In data edited from the book, the use of cod-liver oil to prevent rickets in Finland appeared to reduce the risk for schizophrenia in men 30 years later by as much as 78 percent. But, was this benefit from the vitamin D, the vitamin A or the omega 3 fats found in cod liver oil? This second study shows us that the omega-3 fats are playing an important role in this protection, and perhaps at any age preceding the onset of psychosis. It would break my heart if you didn’t take your omega 3 supplements.

Resistance training and executive functions: a 12-month randomized controlled trial.
Arch Intern Med. 2010 Jan 25;170(2):170-8.
Brain Research Centre, Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Department of Physical Therapy, University of British Columbia. 357-2647 Willow St, Vancouver, BC V5Z 3P1, Canada.

According the authors, among community-dwelling women aged 65 to 75 years, 12 months of progressive resistance training once or twice weekly improved selective attention and conflict resolution relative to twice-weekly balance and toning exercises. They also found that resistance training twice weekly improved peak quadriceps muscle power. This is the first study to demonstrate that engaging in progressive resistance training as infrequently as once a week can significantly benefit executive cognitive function in community-dwelling senior women.

In the same issue were two additional corroborating studies…

Physical activity and incident cognitive impairment in elderly persons: the INVADE study.
Arch Intern Med. 2010 Jan 25;170(2):186-93. Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany. Conclusion: Moderate or high physical activity is associated with a reduced incidence of cognitive impairment after 2 years in a large population-based cohort of elderly subjects.

Physical activity at midlife in relation to successful survival in women at age 70 years or older. Arch Intern Med. 2010 Jan 25;170(2):194-201. Department of Nutrition, Harvard School of Public Health, 655 Huntington Ave, Boston, MA 02115, USA. Conclusion: These data provide evidence that higher levels of midlife physical activity are associated with exceptional health status among women who survive to older ages and corroborate the potential role of physical activity in improving overall health.

These data validate the Jack Lalanne phenomenon and the message in the Vitamin D Cure. Eat healthy, exercise hard, take some targeted supplements like vitamin D, omega 3 and magnesium, and you will live a long, healthy and vigorous life.

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 Dr Dowd,

… I have been suffering with joint pain, muscle weakness, bone pain for 3 years. I am a 52 year old female. It was hard moving, getting up from a chair, holding heavy objects in my hands and so on. I have gone to physical therapist, with not much change. I have seen rheumatologists and also an endocrinologist…with no relief. I was given Lortab and steroids. They help for a little while. Last May my vitamin D was measured and was 20 or insufficient. My then rheumatologist told me to just supplement with D 3. Recently I bought a chewable D 3 1000 from GNC for my son and took one myself. The next day when I woke up, it was like I had gotten a huge steroid shot. It was unbelievable. I felt relieved. My pain was very minimal. My low back pain was gone. My back has been a problem for more than 3 years. … I bought your book last night and read it from beginning to end. …

Thank you,
Judy, from MI

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!

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.

Roasted Tomato and Vegetable Soup

Yield: 8 servings (1 1/3 cup)

Ingredients:
• 1 medium onion, chopped
• 1 stalk celery, sliced
• 1 medium carrot, chopped
• 2 cloves garlic, minced
• 1 Tbsp. olive oil
• 3 14-oz. cans chicken stock (low sodium)
• 2 cups butternut squash; peeled, seeded and cut into 1-in. pieces
• 1 14.5-oz. can fire-roasted diced tomatoes
• 1 15-to 19-oz. can cannellini beans, rinsed and drained
• 1 medium zucchini, halved lengthwise and sliced
• 1 cup small broccoli and/or cauliflower florets
• 1 Tbsp. fresh oregano, chopped
• 1/4 tsp. salt
• 1/4 tsp. black pepper

Directions:
• In a 4-quart pot, cook onion, celery, carrot, and garlic in hot oil over medium heat until tender, about 5 minutes.
• Stir in chicken stock, squash, and undrained tomatoes. Bring to a boil, reduce heat and simmer for 20 minutes covered.
• Add beans, zucchini, broccoli and/or cauliflower, oregano, salt and pepper; cook for another 5 minutes.
• Slow Cooker Option: Omit the olive oil and combine all ingredients except the zucchini, broccoli and/or cauliflower and fresh oregano in slow cooker. Cover and cook on low for 7 to 8 hours or on high for 3 to 4 hours. Add zucchini, broccoli and/or cauliflower and fresh oregano and cook 30 minutes more on high.
• You can have a grilled chicken breast or nice piece of white fish with a bowl of this soup.

Vitamin D in the News

In the book we speculated that HIV transmission might be greater with lower vitamin D levels. This data from Africa and Harvard suggests that the spread of HIV in Africa particularly between mother and child is at least in part due to lower vitamin D levels. These data also suggest that our lifestyles that lead to low vitamin D levels and malnutrition are facilitating another epidemic, HIV/AIDS.

High frequency of vitamin D deficiency in ambulatory HIV-Positive patients.AIDS Res Hum Retroviruses. 2009 Jan;25(1):9-14.
Infectious Disease Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.

Several reports have suggested an increased prevalence of osteopenia and osteoporosis in HIV-infected individuals. Vitamin D deficiency may be a risk factor for osteoporosis and bone fractures. These researchers determined the prevalence of vitamin D insufficiency in an outpatient HIV clinic in Boston. They collected serum levels of 25-OH vitamin D and evaluated calcium and vitamin D intake in adult HIV-positive outpatients during the winter and spring of 2005. Fifty-seven subjects were enrolled. The prevalence of moderate (< or = 20 and>10 ng/ml) and severe (< or =10 ng/ml) 25-OH vitamin D deficiency was 36.8% and 10.5%, respectively. Lower vitamin D intake was significantly associated with severe 25-OH vitamin D deficiency (p=0.01). Lactose intolerance tended to be associated with severe vitamin D deficiency (p=0.08). Antiretroviral use and low daily calcium intake were significantly associated with elevated parathyroid hormone levels (p=0.01 and 0.03, respectively). Vitamin D deficiency was frequent in ambulatory HIV-positive patients. HIV-infected individuals living in areas with low exposure to ultraviolet light during winter may benefit from vitamin D supplementation.

Perinatal Outcomes, Including Mother-to-Child Transmission of HIV, and Child
Mortality and Their Association with Maternal Vitamin D Status in Tanzania.
J Infect Dis. 2009 Aug 12.
Departments of Epidemiology, Nutrition, Biostatistics, and Global Health and Population, Harvard School of Public Health, and Channing Laboratory, Department Of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; Departments of Internal Medicine, Pediatrics, and Community Health, Muhimbili University of Health and Allied Sciences, Dares Salaam, Tanzania.

Background. Vitamin D is a strong immunomodulator and may protect against adverse pregnancy outcomes, mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV), and child mortality. Methods. A total of 884 HIV-infected pregnant women who were participating in a vitamin supplementation trial in Tanzania were monitored to assess pregnancy outcomes and child mortality. Results. No association was observed between maternal vitamin D status and adverse pregnancy outcomes, including low birth weight and preterm birth. In multivariate models, a low maternal vitamin D level (<32 ng/mL) was associated with a 50% higher risk (95% confidence interval [CI], 2%-120%) of MTCT of HIV at 6 weeks, a 2-fold higher risk of MTCT of HIV through breast-feeding among children who were HIV uninfected at 6 weeks (95% CI, 1.08-3.82), and a 46% higher overall risk of HIV infection (95% CI, 11%-91%). Children born to women with a low vitamin D level had a 61% higher risk of dying during follow-up (95% CI, 25%-107%). Conclusions. If found to be efficacious in randomized trials, vitamin D supplementation could prove to be an inexpensive method of reducing the burden of HIV infection and death among children, particularly in resource-limited 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.

Dr. Dowd,

First I’d like to say that your book has made quite an impact on my life. Because I have a sun-sensitive porphyria I have always avoided sunlight, but over the years that led to constant battles with viruses, anemia, and eventually heart failure and cancer. I became convinced that many of my problems were related to a vitamin D deficiency so I had my blood checked and sure enough I was deficient in spite of excellent DEXA scans.

I tried various levels of exposure to see what I could tolerate without triggering a porphyria attack and have come up with 15 minutes between 9 and 10am MST (Colorado) or after 4pm. I’ve done this three times a week most of the summer and my recent kidney scan showed that my cancer had decreased in size. My overall health is getting much better including my heart and lung function and viral load (I had viral pneumonia, CMV and Parvo all at one time!). Thanks so much for your work.

Janet, Colorado Springs

Many patients with diseases that prevent them from getting adequate sun exposure are vitamin D deficient. Supplementation using the tables in The Vitamin D Cure is safe, convenient, and inexpensive