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!

The Vitamin D Cure is now available in paperback! Now your healthy new lifestyle manual will cost you even less. It’s a great gift idea as well.

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 not exactly Paleolithic. It has peas which were not routinely consumed by primitive cultures. However, it is loaded with chlorophyll and is a great compliment to a lean piece of meat either on the side or chopped up and put directly into the soup. And, it tastes fantastic!

Green Pea Soup with Tarragon & Pea Sprouts.

Ingredients

2 16-oz. packages frozen sweet green peas, divided
2 Tbsp. canola oil
3 shallots, chopped
1 clove garlic, chopped
1 qt. vegetable stock
3 Tbsp. fresh tarragon, chopped and divided
Pea Sprouts
1 Avocado

Preparation:

1. Place 1 cup of peas in a bowl and set aside.
2. Heat oil in a large saucepan over medium high heat and sauté shallots until golden and tender. Add garlic and sauté 1 additional minute.
3. Add remaining peas, vegetable stock, and 2 Tbsp. of chopped tarragon; bring to a boil.
4. Reduce the heat and continue simmering until the peas are tender and the flavors have developed, about 10 minutes.
5. Either with an immersion blender or in small batches in a blender, purée the soup until completely smooth.
6. Return the soup to the saucepan and bring back to a simmer, adjusting consistency with more stock if desired.
7. Stir in remaining tarragon and season with salt and pepper.
8. Mash avocado and mix with a squeeze of fresh lemon juice.
9. To serve, top with whole peas (heated in microwave for 1 minute), pea sprouts and a dollop of guacamole, if desired.

Vitamin D in the News

Do Melanoidins Induced by Topical 3% Dihydroxyacetone Sunless Tanning Spray Inhibit Vitamin D Production? A Pilot Study. Photochem Photobiol. 2009 May 28.
Osteoporosis Research Center, Creighton University, Omaha, NE.

They report preliminary study data of the effect of sunless tanning spray with 3% dihydroxyacetone (DHA) on 25-hydroxyvitamin D [25(OH)D] serum levels in volunteers exposed to controlled amounts of UV-B radiation during April/May in Omaha, NE, 41 degrees N latitude. They found that DHA-induced melanoidins in skin act as a topical sunscreen reducing the formation of vitamin D (25(OH)D).

Vitamin D nutritional status of exclusively breast fed infants and their mothers. J Pediatr Endocrinol Metab. 2009 Mar;22(3):241-6. Department of Pediatrics, Kalawati Saran Hospital, New Delhi, India.

As I said in the Vitamin D Cure, vitamin D has a profound effect on the development of an infant. It follows then that the vitamin D status of mothers and their infants are tied together. Studies in Pittsburgh and Philadelphia have shown wide spread deficiency in mother-infant pairs at 42 degrees north latitude. This study shows us that even in equatorial regions of the globe deficiency is wide spread. Study Design: 180 healthy lactating mothers and exclusively breast fed infants, 2-24 weeks old had clinical, biochemical and hormonal evaluation for calcium-vitamin D-PTH axis. Results: The average serum vitamin d 25(OH)D values in lactating mothers was 27.2 +/- 14.6 nmol/l (10.9 +/-5.8 ng/ml), while that of their infants was 28.9 +/- 20.8 nmol/l (11.6 +/- 8.3 ng/ml). Remember 80 nmol/L or 32 ng/mL is the bottom end of the normal range for vitamin D levels. Serum 25(OH)D levels <25 nmol/l (10 ng/ml) were found in 47.8% of the mothers and 43.2% of the infants. Among these, elevated PTH levels (>54 pg/ml) were seen in 59.3% of the mothers and 69.6% of the infants. A highly significant negative correlation was found between serum 25(OH)D and PTH in mothers (r = -0.480, p = 0.01) and their infants (r = -0.431, p = 0.01). A strong positive correlation was seen of vitamin D 25(OH)D levels in mother-infant pairs (r = 0.324, p = 0.001). Conclusions: A high prevalence of vitamin D deficiency was found in lactating mothers and their exclusively breast fed infants. Infants born to mothers with low vitamin D had 3.8 times higher risk of developing low vitamin D as compared to those born to mothers with normal vitamin D levels.

Dietary vitamin D and cancers of the oral cavity and esophagus. Ann Oncol. 2009 Jun 1. International Epidemiology Institute, Rockville, MD.

We discussed the relationship between diet and vitamin D and colon cancer in The Vitamin D Cure. This study looks at that relationship with esophageal and oral cancer Methods: The researchers examined the relation between dietary vitamin D intake and squamous cell carcinoma of the esophagus (SCCE; 304 cases) and oral/pharyngeal cancer (804 cases) in two case-control studies in Italy. Odds ratios(ORs) and 95% confidence intervals (CIs) were estimated by multiple logistic regression. Results: Adjusted ORs for SCCE and oral/pharyngeal cancer were 0.58 (95% CI 0.39-0.86) and 0.76 (95% CI 0.60-0.94), respectively, for the highest tertile of vitamin D intake. Compared to the highest tertile of vitamin D who were never/former smokers, ORs were 8.7 (95% CI 4.1-18.7) for SCCE and 10.4 (95% CI 6.9-15.5) for oral/pharyngeal cancer among heavy smokers in the lowest vitamin D tertile; similarly, compared with those in the highest tertile of vitamin D who drank <3 alcoholic drinks/day, corresponding ORs were 41.9 (95% CI 13.7-128.6) for SCCE and 8.5 (95% CI 5.7-12.5) for oral/pharyngeal cancer, among heavy alcohol drinkers in the lowest vitamin D tertile. Conclusion: They observed an estimated 25-40 percent reduction in risk for oral/pharyngeal cancer and SCCE respectively with greater risk reductions in the absence of alcohol use or smoking.

Does vitamin d reduce the risk of dementia? J Alzheimers Dis. 2009 May;17(1):151-9.
Sunlight, Nutrition, and Health Research Center (SUNARC), P.O. Box 641603, San Francisco, CA 94164-1603, USA.

In the Vitamin D Cure we talk about how vitamin D is important for brain development, how it facilitates learning and protects the brain from injury. This article develops the hypothesis that vitamin D can reduce the risk of developing dementia, presenting the evidence from observational and laboratory studies. The observational evidence demonstrates that low serum 25-hydroxyvitamin D [25(OH)D] has been associated with increased risk for cardiovascular diseases, diabetes mellitus, depression, dental caries, osteoporosis, and periodontal disease, all of which are risk factors for dementia or precede the development of dementia. The laboratory evidence includes several findings on the role of vitamin D in neuroprotection and reducing inflammation. This is a great review of the current data linking vitamin D and risk for dementia.

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.

This month’s success story comes from Tom with seasonal allergies.

Hello,
I have a question about allergies.
I have suffered from seasonal allergies in May and June all my life. Until I was diagnosed with obstructive sleep apnea and had to wear a mask when I slept I just put up with them. However, constant sneezing and a runny nose were intolerable while wearing a CPAP mask. I finally went to an allergist and had scratch tests done and I had the strongest ranked reactions to all three types of grasses tested. However, due to glaucoma in one eye the allergist could not treat me. I then just used prescription antihistamine during my allergy season.

Now that I am taking vitamin D and eating a modified paleo/chimpanzee diet my allergies are gone this season for the first time. (I modify the Paleolithic diet by eliminating red meat from my diet for male chimpanzees suffer from interstitial myocardial fibrosis and the only difference between male and female chimps is that males hunt red meat, eat red meat, and as a rule do not share it with female chimps.) Is this grass allergy elimination possible or simply a coincidence? In short it is a miracle. Part of me thinks, “Wheat is a grass and you are allergic to grass so cutting out wheat only made sense in retrospect.”

Do other people with grass allergies find good results by going paleo and taking the vitamin D cure? I am shocked it could work so fast.

Thank you,
Tom

The simple answer is yes. The explanation is unclear and involves many variables. Allergies are determined likely in the first 24 months of life based on vitamin D levels, passive immunity from breast feeding, and exposure to other plant and animal proteins in our diet. Higher vitamin D intakes during pregnancy appear to lower the risk for asthma later in childhood. Heliotherapy in adults with eczema seems to have a clearing effect on this skin disease. However, some studies of vitamin D intake in childhood seem to point to higher likelihood of developing allergies. The science is still up in the air. I suggest following Mother Nature’s lead. We should be in the sun more than we are now, we should all be breast fed as infants, and we should not consume grain or dairy as adults.

Get your copy of The Vitamin D Cure, lay out in the sun and have a good read!

The short answer is Not D2.

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 occuring in 1-2 weeks. The biological half life of D3 as determined by submarine mariners is about 10 weeks. There has 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 see 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. Unfortuanately, 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 costs about 25 dollars. The copay for a Drisdol (D2) prescription is likely to be as much for every month’s supply. You can get Carlson Labs vitamin D at many online retailers for very low cost including shipping.

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 prescision 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.

One of the common themes throughout the book is replace grAIn with grEEn. Green vegetables have loads of vitamin K, some vitamin D2, magnesium and many other trace nutrients that are not found in grain. All of these nutrients are important for our health and well-being.

A study published this month from the Framingham Offspring Database (the children of the first generation of study participants) showed a significant reduction in blood markers of inflammation with higher vitamin K and to a lesser extent vitamin D levels. In other words, more green vegetables in your diet throughout your life reduces inflammation. A higher vitamin D level especially during fetal development and in early childhood ensures that your immune system develops normally.

For more information on vitamin D and vitamin K and how they affect inflammation in you, get the book and read chapters, 2 and 11 and jump into the program.

Have you had lunch with your son or daughter at their school cafeteria? You should try it one day. Typical menus include cheese nachos, tacos, pizza, soda pop, dessert and vending machine snacks. I remember when only the poorest and the wealthiest students bought their lunches. I always brought my lunch.

The menus in our schools are horrific. I have seen several children just this year who have nothing more than malnutrition as the primary cause of their aches, pains and fatigue. Vitamins A, B and D levels in their blood work are all well below normal. They have no chance of being healthy adults on these diets.

Make sure your kids get a healthy breakfast with MEAT and VEGETABLES. No more cereal for breakfast; its junk food. The most important missing ingredient in children’s diets is green leafy vegetables.

If you want your kids to be strong and healthy go LEAN and GREEN in the kitchen.

Happy Thanksgiving!