Vitamin D Newsletter
March 20, 2011
In This Issue
Dr. Cannell reviews five studies in this preview edition of the new members-only Vitamin D Newsletter.
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Contact us Studies of Interest 1
This is the first in a new edition on the Vitamin D Council’s newsletters. Unlike the general newsletter, this newsletter will eventually only be available to those who subscribe as members of the Vitamin D Council, but it will be posted on our website four months after being sent to subscribers. Lack of adequate donations made this necessary but we believe the cost of membership (five dollars per month) is not excessive.
Become a member of the Vitamin D Council now for only $5.00/month with an automatic recurring charge every month, which lets us budget better!
The format of this subscribers-only newsletter will usually be my explanation and analysis of recently published vitamin D studies. Sometimes the studies will only be a few days old, others a few weeks or months. Some, if not well-known, may be several years old. All of the studies discussed will be notable.
We will also consider printing replies by the authors, as some may not like my commentary. So, it should be interesting to those interested in vitamin D and useful as the list of diseases connected to vitamin D continues to grow.
The second advantage of becoming a member of the Vitamin D Council will be access to a new feature, videos of Dr. Cannell answering questions and discussing vitamin D. Be on the lookout for an email in several days with a link to such a video. $5.00/month is a wise investment in your health.
Become a member of the Vitamin D Council now for only $50.00/year. This is a one time charge that will need to be redone every year to maintain membership.
McKinney JD, Bailey BA, Garrett LH, Peiris P, Manning T, Peiris AN. Relationship between vitamin d status and ICU outcomes in veterans. J. Am Med Dir Assoc. 2011 Mar;12(3):208-11.
Dr. Jason McKinney and colleagues of the Eastern Tennessee State University and the Mountain Home VA Medical Center asked a simple question, do ICU patients die more frequently if they are vitamin D deficient? The authors reviewed records of 136 veterans who were hospitalized in the intensive care unit and who happened to have a vitamin D blood level done a within a month of that hospitalization. No matter the reason for the hospitalization and no matter whether the vitamin D level was drawn before or after the hospitalization, the answer is yes, vitamin D deficient ICU patients are almost twice as likely to die. I particularly liked their tongue in cheek conclusion, ". . . it appears current dosing does not satisfactorily address vitamin D deficiency in the severely ill."
My advice is to have some 50,000 IU capsules from Bio Tech Pharmacal on hand in the house, in the medicine cabinet not the vitamin cabinet. If someone you love is in the hospital (not just the ICU) and they have not been taking adequate doses of vitamin D, give them 50,000 to 100,000 IU/day for the first 3-4 days of their hospitalization.
McGrath JJ, Eyles DW, Pedersen CB, Anderson C, Ko P, Burne TH, Norgaard-Pedersen B, Hougaard DM, Mortensen PB. Neonatal vitamin D status and risk of schizophrenia: a population-based case-control study. Arch Gen Psychiatry. 2010 Sep;67(9):889-94.
Professor John McGrath is getting closer to proving his theory that schizophrenia is connected to vitamin D deficiency. He is, of course, saying that African Americans have higher rates of schizophrenia than do Whites, a fact every psychiatrist knows to be true but a fact that violates the politically inviolate "no racial differences in diseases above the neck" rule. In this paper, he and his colleagues add to the evidence vitamin D is involved in schizophrenia, finding low vitamin D levels at birth increase risk in teenagers and young adults (14-27 years old). However, the dreaded U-shaped curve again reared its head. The authors found that levels of 16-20 ng/ml at birth afforded the best protection 14-27 years later. That’s right, 16-20 ng/ml, but levels above and below that were associated with increased risk decades later.
I smell cod liver oil. It turns out that most, but not all, of the U-shaped curves come from Nordic countries, like this study came from Denmark. When found, the U-shaped curve is usually more dramatic in Nordic countries. Again, ask yourself where did the mothers of these kids get their vitamin D? From the seasonal variation, we can estimate that the mothers got about, on the average, 400-600 IU/day from the sun. The rest had to be obtained from diet or supplements. In Denmark, during the 1980s and 90s, the supplement most likely to raise vitamin D levels would have been cod liver oil, which contains all that toxic vitamin A.
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Bhandari SK, Pashayan S, Liu IL, Rasgon SA, Kujubu DA, Tom TY, Sim JJ. 25-hydroxyvitamin d levels and hypertension rates. J Clin Hypertens (Greenwich). 2011 Mar;13(3):170-7. doi: 10.1111/j.1751-7176.2010.00408.x. Epub 2010 Dec 22.
What a paper, just when we are worrying about levels of 20 ng/ml being too high, along comes Southern California, Dr. Simran Bhandari, and his associates at Kaiser Permanente. Using a now defunct Nichols Advantage analyzer, the Kaiser folks asked a question that Nichols Advantage cannot answer, what is the best absolute vitamin D level? However, it is a great question.
What they found was remarkable, the crude odds ratio (risk) of being hypertensive was almost five times higher for those with 25(OH)D levels less than 15 ng/ml compared to those above 40 ng/ml. The same was true for renal function. However, as Nichols Advantage was used, all we can say is look at the differences, not the absolute levels. If you believe Nichols, you believe that 1,812 of 2,722 patients tested had vitamin D levels higher than 40 ng/ml. I doubt it, even in Southern California.
No U-shaped curve in Southern California, not even a suggestion of one. Of course these patients were tested between 2004 and 2006 so some were already on pure vitamin D, not vitamin D contaminated with retinol (cod liver oil). Too bad the authors couldn’t tell us more about the sample, like how many were taking vitamin D? Some of the Kaiser hospitals are in the forefront of vitamin D supplementation. Kaiser Permanente seems to know that vitamin D is the answer to those vexing medical care cost questions.
Lindh JD, Andersson ML, Eliasson E, Bjorkhem-Bergman L. Seasonal variation in blood drug concentrations and a potential relationship to vitamin D. Drug Metab Dispos. 2011 Feb 24. [Epub ahead of print]
From the Karolinska Institute in Stockholm, Sweden comes the first of what I hope will be many studies on how vitamin D affects the prescription drugs people take. Dr. Jonatan Lindh and his colleagues found that some commonly prescribed immunosuppressants have seasonal variations in their blood levels and that seasonality is directly related to vitamin D levels. It turns out that vitamin D increases levels of a key enzyme made by the liver (CYP3A4) and increased levels of CYP3A4 means that blood concentrations of certain prescription drugs will be lower.
Theoretically those drugs include a long list, including the SSRIs citalopram, escitalopram, fluoxetine, norfluoxetine and sertraline, and the antipsychotics aripiprazole, haloperidol, risperidone and ziprasidone. I only mention those because I am a psychiatrist. For a full list of drugs that may have lower blood levels because of vitamin D increasing CYP3A4, look up CYP3A4 in Wikipedia and read about the enzyme. Again, vitamin D increases the liver’s production of this vital enzyme, an enzyme which then lowers levels of the drugs it catabolizes (breaks down).
Neyestani TR, Hajifaraji M, Omidvar N, Eshraghian MR, Shariatzadeh N, Kalayi A, Gharavi A, Khalaji N, Haidari H, Zowghi T, Nikooyeh B. High prevalence of vitamin D deficiency in school-age children in Tehran, 2008: a red alert. Public Health Nutr. 2011 Feb 28:1-7. [Epub ahead of print]
A few weeks ago someone finally issued a red alert for our children, how vitamin D deficiency may be injuring them in ways we can’t imagine. I love how the authors wrote that their findings should be "regarded as a public health emergency by all stakeholders." Indeed, who is not a stakeholder when it comes to our 9-12 year-old children?
At 35 degrees North, Dr. Tirang Neyestani and colleagues in Tehran, Iran, found that in the winter, 91% of the children had vitamin D levels lower than 20 ng/ml, 86% lower than 15 ng/ml, and an unbelievable 38% had vitamin D levels lower than 5 ng/ml. For reasons I will not repeat, low levels are usually more reliable than high levels and this study used the German made "Immunodiagnostik" method to measure vitamin D levels.
Red alert it should be in the USA but no, we have just been subjected to the opinion of a seemingly well-intentioned group of apparently unbiased scientists from the Food and Nutrition Board who said that vitamin D is for bone and bone alone and levels of 20 ng/ml are just fine. Natural selection will take care of those who actually believe that.
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John Cannell, MD
Executive Director, Vitamin D Council
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