vitamin D

For those questions and discussions on the McDougall program that don’t seem to fit in any other forum.

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vitamin D

Postby shell-belle » Thu Jan 26, 2012 4:30 pm

I subscribe to the Vit D Newsletter that comes by email. I emailed the newsletter and asked the doctors there to
comment on what Dr Mc Dougall said about vit D supplementation -
which was this:

“The overall harmful effects caused by nutritional imbalances created by taking these pills are far from fully understood; however, there is sufficient evidence that taking vitamin D by mouth may increase your risk of heart disease, several forms of cancer, and kidney stones. In addition, recent studies have suggested levels of 25-hydroxy-vitamin D above 60 ng/mL are associated with an increased risk of pancreatic cancer, vascular calcification, and death from any cause.”

here is the reply I got:

Who's Dr. John McDougall? It's hard to comment without really knowing what studies he is speaking of. We always comment on studies immediately to clarify findings when vitamin D gets "bad" press.

To date, there are no controlled trials that show an increased risk when supplementing with vitamin D in...
Cancers
Heart disease
Kidney stones

Regards,
Brant Cebulla
Development Director
Vitamin D Council
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Re: vitamin D

Postby Kiki » Thu Jan 26, 2012 5:07 pm

I think they are hiding behind language. The key is 'controlled trials' instead of studies or scientific evidence. Dr. McDougall points to cohort studies and case-control studies, which are lesser in the world of science, but not worthless.

Dr. McD starts here: http://vitamindwiki.com/tiki-download_w ... ?attId=497
Moreover, the report provided evidence suggestive of a significantly increased risk of pancreatic cancer at high 25-hydroxyvitamin D levels (≥40 ng per milliliter).(5) An increased risk of esophageal cancer at higher 25-hydroxyvitamin D levels has also been reported.

That source points to this one: http://aje.oxfordjournals.org/content/e ... wq119.full
Across each cancer site, there was no evidence of a protective association between higher concentrations of 25-hydroxyvitamin D (>75 nmol/L) and cancer outcome. An increased risk at very high levels (≥100 nmol/L) was noted for pancreatic cancer, confirming previous reports.

And, that article points to this one: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892539/

And that one points to this nested case-control study:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907505/
Although recent prospective epidemiologic studies of higher predicted vitamin D status score and vitamin D intake and pancreatic cancer risk suggest protective associations, a nested case-control study showed a significant 3-fold increased risk for pancreatic cancer with higher vitamin D status.

and there are some others for some of the other diseases, etc. It's kind of a pain to track down though.
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Re: vitamin D

Postby bcebulla » Thu Jan 26, 2012 7:40 pm

The problem with pointing to retrospective observational studies as basis to show that vitamin D is associated with increased risk in bad health outcomes is that when it comes to vitamin D, there are literally thousands of observational studies that show, the higher your vitamin D blood level (0-60 ng/ml), the better the health outcome across a broad spectrum of diseases. These studies receive a lot of media attention, but not nearly as much attention the very rare "vitamin D is bad" finding receives. Much to our organization's disappointment, when the latter type of news story breaks, some doctors are quick to pick them up, despite not having any thorough understanding or background on the literature of the topic

There is very strong evidence that show that vitamin D plays a role in preventing cancer, including pancreatic cancer. To say the opposite, as Dr. McDougall does, would leave anyone familiar with the literature dumbfounded. In a study just published this month in the journal of Cancer Epidemiology, Biomarkers and Prevention found that, "Among participants in five large prospective cohorts, higher plasma levels of 25(OH)D were associated with a lower risk for pancreatic cancer."

http://www.ncbi.nlm.nih.gov/pubmed/22086883

The only randomized controlled trial looking at vitamin D supplementation and cancer outcomes using a somewhat significant dose of vitamin D (1100 IU, still very low dose) to date found a 77% reduction in all-type cancer incidence in comparing vitamin D to placebo.

http://www.ncbi.nlm.nih.gov/pubmed/17556697

Similar evidence from observational studies exists for an association between high vitamin D levels and lower cardiovascular disease incidence. From the Archives of Internal Medicine: "Low 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels are independently associated with all-cause and cardiovascular mortality. A causal relationship has yet to be proved by intervention trials using vitamin D." Note the last sentence. We really need randomized controlled trials to tell us whether vitamin D plays a beneficial role in cardiovascular disease, but there is a ton of observational literature that shows potential benefit in vitamin D for CVD outcomes. To say the opposite, again, is dumbfounding.

Vascular calcification? Again, studies show that vitamin D has an inverse relationship with coronary artery calcification. "In conclusion, lower 25-hydroxyvitamin D concentrations associate with increased risk for incident coronary artery calcification."

http://www.ncbi.nlm.nih.gov/pubmed/19443637

Renal stones? No study has found vitamin D, independent of high calcium supplementation, to increase the incidence of kidney stones.

As far as all-cause mortality goes, there are many observational studies that show a linear relationship between high vitamin D levels and lowered risk of all-cause mortality. There are a couple of "u-shaped curves" that show a "sweet spot" for vitamin D, which is what you would expect from a fat-soluble vitamin and prohormone. This is another conversation, but we believe any objective look at current literature would tell you, you probably need to supplement with vitamin D, you probably aren't getting enough sun exposure with your 21st century lifestyle.

Regards,
Brant Cebulla
Vitamin D Council
bcebulla@vitamindcouncil.org
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Re: vitamin D

Postby Kiki » Thu Jan 26, 2012 8:39 pm

Brant, thanks for joining in the discussion and stating your position so clearly. You are right that I, personally, need to supplement with vit D as I have frank osteomalacia by every definition that I've seen (6 ng/ml), and am in excruciating pain when I don't. The trouble is figuring out how much to supplement.

It would be nice to hear back from Dr. McDougall on this one. Perhaps if this thread were moved to the 'newsletter' forum, he might see it.
Kiki
 

Re: vitamin D

Postby stoumi » Fri Jan 27, 2012 10:12 am

All this reading about Vitamin D from these discussion boards, as well as Jeff Novick's comments have me more confused than when my doctor told me I needed a supplement. I am losing more faith in my doctor looking out for my health, but do I starting citing articles and telling him he is wrong or I am not going to follow his recommendation??
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Re: vitamin D

Postby GeoffreyLevens » Fri Jan 27, 2012 11:15 am

The trouble is figuring out how much to supplement.

The amount to supplement is the amount it takes to keep you in the middle of the "normal" range ie around 45 or 50 ng/ml. Everyone is different so the only way you can know, the one and only way, is to test. Doctors often prescribe massive doses weekly for awhile. The problem with that is 1) easy to overshoot the mark and get too much and 2) more importantly, when you do get to a good level, you still have not idea how much you need to take. I initially did it this way on my own body, advised by my doctor, because I didn't know any better.

I think a much better way (just my opinion!) is to start w/ 1000 or 2000 ui/day above what you were taking at the time of first test. So if you weren't taking any, than 2000 i.u./day. etc... Test after 6-8 weeks and if low, increase dose by maybe 1000 i.u./day. When you hit the sweet spot, you will already most likely be at maintenance dose. They you do need to test once a year or so because your individual intake need may change and you don't want to little or too much.
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Re: vitamin D

Postby Katydid » Fri Jan 27, 2012 11:31 am

Based on the series of videos by Dr. Greger on Vitamin D, I decided on 2000 units of D2 a day. Whether this is adequate or not remains to be seen. My next blood test is in May.

http://nutritionfacts.org/videos/resolv ... in-d-bate/

Kate
This diet can save your life - it saved mine! Read my story at:
http://www.drmcdougall.com/stars/cathy_stewart.htm
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Re: vitamin D

Postby bcebulla » Fri Jan 27, 2012 12:08 pm

Our organization’s recommendation for healthy adults is to maintain blood levels of 25(OH)D between 40-80 ng/ml, with a level of 50 ng/ml being the primary target. Geoffrey Levens here seems to have a little familiarity on the topic.

This rationale is based on human physiology and observational studies, as there are not enough randomized controlled trials in current literature to guide the medical field. But when we look at equatorial hunter-gatherer populations, who receive consistent year-round sun exposure, we see blood levels right around 50 ng/ml, without supplementation.

http://www.ncbi.nlm.nih.gov/pubmed/22264449

This suggests that the human genome evolved to maintain vitamin D blood levels around 50 ng/ml, and in theory, this is the level the body needs for optimal health.

Please see the chart below on the average daily supplement it takes to achieve a targeted blood level when you know your current blood level. Longtime vitamin D researchers believe that a physiologic daily dose is 4000-5000 IU/day, as that typically places adults in the 50 ng/ml area. If this sounds like a lot, keep in mind that the skin produces 8,000-10,000 IU after a good day’s exposure to the sun, burning avoided.

http://blog.vitamindcouncil.org/wp-cont ... itled4.jpg

Many people make the mistake in thinking that vitamin D supplementation, as recommended or prescribed by their doctor, is a supplement that only needs to be taken for a short period, and then they’re sufficient again. This is false; the body uses vitamin D, will clear its metabolites and 25(OH)D has a half-life of 2-3 weeks. A vitamin D supplement needs to be taken as a maintenance dose in the absence of sun exposure. In the wintertime, this means the majority of the United States should be taking a supplement.

http://www.vitamindcouncil.org/about-vi ... vitamin-d/

Brant Cebulla
Vitamin D Council

bcebulla@vitamindcouncil.org
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Re: vitamin D

Postby bcebulla » Fri Jan 27, 2012 12:13 pm

Also, D3 (over-the-counter), believe it or not, is more efficacious than D2 (prescribed by your doctor). D3 is human/animal vitamin D while D2 is plant vitamin D.

A meta-analysis of 50 randomized controlled trials (this is good science) show that D3 reduces mortality risk, while D2 does not.

http://www.ncbi.nlm.nih.gov/pubmed/21735411
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Re: vitamin D

Postby shell-belle » Fri Jan 27, 2012 12:46 pm

Thanks for your informative posts Brant. 3 years ago I had my vit D level tested and it was 43. I began taking 10,000 IU of D3 and did so daily for 5 months. Then I got retested. My level was then 89.9. My doctor said that number was high but not toxic. She told me to cut back to 2000 IU a day for awhile. So I did. I went on 2000 IU for about 6 more months then got tested once again and my number was at 73. So I now take 5000 IU a day during the winter and 2000 IU a day in spring summer and fall.
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Re: vitamin D

Postby didi » Fri Jan 27, 2012 1:09 pm

Exactly what is the vitamin D council? Who are the members and how is it funded? Do you do your own research?

It wonders me exactly what the problem with D is when just about everyone has low levels. I have read posts from some who say they have low levels despite quite a bit of time in the sun each day. People who live in AZ have notoriously low levels of D. In a way I can understand this because when I am there I spend as little time as possible in the sun and hundred degree temperatures.

If lack of D is responsible for calcification of the arteries, why do Esselstyn's patients and others on a plant based diet reverse their artery disease and live much longer than their physicians predicted? There are no reports of Esselstyn requiring large doses of vitamin D.

Lots of degenerative diseases (which we have been told are all facets of the same disease) are reversed with a low fat plant based diet and I have not heard reports of these people using large doses of D. Overweight people do have lower D levels because the D is stored in the fat. Would their requirements be lower if they lose weight?

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Re: vitamin D

Postby GeoffreyLevens » Fri Jan 27, 2012 1:55 pm

Didi, too many variables. Dr E's patients had life expectancies of a few years at most. The only way to answer in regards to his patients would be to compare those who followed his diet and had low blood levels of D with those who followed his diet and had "normal range" levels. And you would have to follow them for at least 20 or 30 years to get good study results and really, you would need thousands of subjects. Artery calcification is only one factor out of many that may be effected by vitamin D.

You don't see reports of people using "large doses of D" because large doses is not the issue. Blood level is the issue.

Rather than ask what is the problem with vitamin D, maybe a better question would be what is wrong w/ so many people's lifestyles, diets, metabolisms, environments that is causing so many to test low. It is true that we don't have historical data to compare blood levels of say 100 years ago, but the many, large, observational studies definitely point to strong benefits to have "mid normal range" blood level.
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Re: vitamin D

Postby EmmetFitzhume » Fri Jan 27, 2012 2:24 pm

didi wrote:It wonders me exactly what the problem with D is when just about everyone has low levels.



Modern people get too little sunlight exposure. Many who get sunlight exposure use lots of sunscreen which blocks UVB so they can't make D anyway.

Vitamin D deficiency has plagued modern society for quite a while. Rickets was a big problem till they started adding D2 to milk...
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Re: vitamin D

Postby stoumi » Fri Jan 27, 2012 2:31 pm

Based on the chart that Brant provided, I can see understand why my doctor would prescribe the 50,000 IU in order to get my current level up to a "normal" (40-60) level.
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Re: vitamin D

Postby didi » Fri Jan 27, 2012 3:23 pm

Here is some information on vitamin D and tests. Also, read a little about Dr. Cannel.

http://www.nytimes.com/2009/01/08/busin ... btest.html

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