[alac-forum] VITAMIN D IN THE NEWS
VITAMIN D IN THE NEWS
The Vitamin D Newsletter
January 24, 2003
The Vitamin D Council
9100 San Gregorio Road
Atascadero, CA 93422
805 462-8129
http://www.cholecalciferol-council.com
jjcannell@xxxxxxxxxxx
This is a periodic newsletter concerning vitamin D published by the Vitamin D
Council, a non-profit corporation described at the end of this newsletter. Both
the content and tone of this newsletter is the product of the Vitamin D Council
and not of any of the scientists listed below. Any errors are our
responsibility and we encourage readers to alert us to any mistakes. If any
critic can find a substantial error in anything we have printed, we will bring
that error to the attention of our readers, correct it, and confer a free
lifetime subscription to the Newsletter upon the critic. We are particularly
interested in not overstating our case.
All we are asking is for the medical establishment to listen to what the
vitamin D scientists are saying: vitamin D deficiency is widespread and that
deficiency appears to play a significant role (the extent currently
undetermined) in many of the multifactorial chronic diseases that afflict
modern society. You are on the our mailing list because you: have a research
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VITAMIN D IS IN THE NEWS. CONSIDER TODAY?S INDEPENDENT NEWSPAPER, ONE OF THE
BIGGEST NEWSPAPERS IN THE UK.
http://news.independent.co.uk/uk/health/story.jsp?story=483268
IN THE LAST SEVERAL YEARS, MAINSTREAM SCIENTISTS AT MAJOR UNIVERSITIES HAVE
REPORTED AN INCREDIBLE VARIETY OF ILLNESSES ARE ASSOCIATED WITH INADEQUATE
VITAMIN D INTAKE. CONSIDER THE FOLLOWING STORIES REPORTED BY WEBMD.
VITAMIN D MAY PREVENT MS
http://my.webmd.com/content/article/79/96225.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d
VITAMIN D MAY PREVENT ARTHRITIS
http://my.webmd.com/content/article/79/96161.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d
VITAMIN D HAS HEART BENEFITS
http://my.webmd.com/content/article/19/1689_52736.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d
LACK OF VITAMIN D LINKED TO PAIN
http://my.webmd.com/content/article/78/95751.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d
DON'T LET VITAMIN D LEVEL DIP IF YOU HAVE BOWEL DISEASE
http://my.webmd.com/content/article/23/1728_56741.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d
VITAMIN D SUPPLEMENTS MAY PROTECT AGAINST DIABETES IN KIDS
http://my.webmd.com/content/article/35/1728_92680.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d
COULD TOO LITTLE VITAMIN D CAUSE CANCER?
http://my.webmd.com/content/article/77/95337.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d
VITAMIN D AND HYPERPARATHYROIDISM
http://my.webmd.com/content/article/22/1728_56216.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d
VITAMIN D KEY TO COLON CANCER
http://my.webmd.com/content/article/16/1671_53266.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d
VITAMIN D PREVENTS TOOTH LOSS
http://my.webmd.com/content/article/28/1728_61745.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d
VITAMIN D MAY ALLOW FOR LOWER DOSES OF STEROIDS
http://my.webmd.com/content/article/22/1728_55456.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d
Everything from chronic pain, to diabetes, arthritis, bowel disease, multiple
sclerosis, cancer and tooth loss! Of course there are even more conditions
associated with vitamin D deficiency as readers of this newsletter know. The
problem is that other than osteoporosis, osteomalacia and rickets, the quality
of the causation evidence varies from little to suggestive. However, one thing
most Americans seem to believe is that sunlight must be avoided for it causes
skin cancer, especially malignant melanoma. We decided to give a little quiz
about the subject.
1. Imagine that Andrew C. von Eschenbach, M.D., the director of the National
Cancer Institute (NCI), visited his dermatologist who examined him and
diagnosed a small squamous cell cancer on his nose. His dermatologist, who
noted that Dr. von Eschenbach had the quaint custom of regularly exposing his
body to short courses of noonday sunlight on the roof of the National Library
of Medicine, advised Dr. von Eschenbach to now totally avoid the sun. As Dr.
von Eschenbach has read every scientific article ever written on cancer, his
reaction was:
A. He thanked his dermatologist but knowing the prognosis is grim for those
who develop squamous cell skin cancers, went home and wrote a will.
B. He immediately arranged to have a complete examination by an internist as
Dr. von Eschenbach knows his chances of developing internal squamous cell
cancers is much higher after being diagnosed with a squamous cell skin cancer.
C. He knew he must now avoid the sun entirely, so he bought cases of sunblock
and lots of clothes that would totally protect his skin. He vowed to never let
another ultraviolet ray of sunlight ever strike his unprotected skin.
D. He jumped up, smiled broadly, hugged his dermatologist, arranged to have
the skin cancer removed, put some unblock on his face and hands, took of his
shirt and changed into shorts for the walk to his car and then drove home to
tell his loved ones the good news.
The correct answer is D. Dr. von Eschenbach knows that virtually all squamous
cell skin cancers are easily treated when caught early and that fewer than 600
Americans die every year from squamous cell skin cancers compared to tens of
thousands who may be dying from internal malignancies induced by vitamin D
deficiency. Furthermore, he knows the strong inverse relationship between
squamous cell skin cancers and the subsequent development of internal cancers
has been known more than sixty years. He also knows that inverse relationship
led to one of the first modern theories of cancer (that squamous cell skin
cancers conferred immunity against various visceral cancers) which is better
explained by sun exposure increasing both squamous cell skin cancers and
calcidiol levels. Furthermore, he knows that the inverse association between
sun-exposure and several common internal malignancies is robust and has been
documented repeatedly. Furthermore, he knows that one of the best th!
ings he can do to reduce his chance of getting up to 13 different serious
internal cancers is to continue to maintain his healthful levels of serum
calcidiol [25(OH) D] by consistent safe sun exposure. If he preferred to
totally avoid the sun and oily fish, relying on vitamin D supplements instead,
he would need to take between 3,000 to 5,000 IU of cholecalciferol a day to
maintain a 25 (OH)D level above 40 ng/ml.
References:
Apperly FL. The relation of solar radiation to cancer mortality in North
America. Cancer Res 1941; 1:191-5
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2263572&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1536921&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7721513&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1451068&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10350434&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2572900&dopt=Abstract
2. The latest evidence suggests 21,000 Americans die every year from internal
malignancies associated with inadequate UVB exposure?
A. True
B. False
True. Actually Grant feels the number below is an underestimate and is coming
out with an even more frightening estimate.
References:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11920550&dopt=Abstract
3. As malignant melanoma is caused by chronic sun exposure, the incidence of
malignant melanoma is more common on the hands, is more common in those who
work outdoors and is less common in those who use sunscreen.
A. True
B. False
False. Although malignant melanoma does increase with age, the increase is not
dramatic as it is with the skin cancer most clearly associated with chronic
sun-exposure, squamous cell skin cancer. And, unlike squamous cell carcinoma,
malignant melanoma is most common on relatively less exposed areas (backs in
men and upper legs in women), is less common in outdoor workers than indoor
ones and evidence to date does not show regular sunscreen use reduces its
incidence. Instead of being caused by chronic sun-exposure, malignant melanoma
is a multifactorial disease, the sun-exposure component of which appears to be
best explained by repeated intermittent intense exposure (sunburn) in a
population that usually avoids the sun (vitamin D deficient population).
References:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9766557&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10699940&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3179192&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3988369&dopt=Abstract
4. For many years, the regular use of sunblock may have actually increased the
incidence of melanoma?
A. True
B. False
True. Until a few years ago, sunblock usually blocked the burning (and vitamin
D producing) UVB while allowing the more deeply penetrating, UVA. Thus, they
may have contributed to the rising incidence of malignant melanoma by allowing
users to stay in the sun for hours without burning, while their skin soaked up
the highly penetrating UVA radiation. The best sunlight recommendations to
prevent malignant melanoma may turn out to be to regularly expose your entire
unsunblocked skin to very short periods (1/3 the time it takes for your skin to
begin to redden) of direct noonday sunlight during the correct season of the
year being careful to never let your skin get red or burn.
References:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14678916&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9335442&dopt=Abstract
5. Pretend that Kenneth, Director of the National Institute of Environmental
Health Sciences, was asked if the American Academy of Dermatology (AAD)
recommendations to totally avoid sunlight may have helped cause the rising
incidence of melanoma and other diseases over the last 20 years by contributing
to the current pandemic of vitamin D deficiency. What should his answer be?
A. Yes
B. No
Yes. The American Academy of Dermatology press releases and spokesmen
(http://www.aad.org/PressReleases/VitD_Sunshine.html) are particularly
misinformed about vitamin D and appear to be giving information that increase
the risks of developing a multitude of vitamin D deficiency related illness
(including hypertension, heart disease, cancer, autoimmune disease, diabetes,
depression, and, perhaps, even malignant melanoma). Raymond L. Cornelison Jr.,
MD, President of the American Academy of Dermatology said, ? People who
practice proper sun protection and are concerned that they are not getting
enough vitamin D should either take a multivitamin or drink a few glasses of
vitamin D fortified milk every day. The dangers of exposing oneself to
carcinogenic UV light from the sun, even for a few minutes, are firmly
established, particularly since dietary intake of vitamin D can completely and
easily fulfill our needs.?
Dr. Cornelison and the AAD are putting their member dermatologists at risk for
future malpractice liability with such incompetent advice. When dermatologists
assume control of the vitamin D system by recommending their patients terminate
sun-exposure, they are required to ensure their patients have an adequate
vitamin D status and that can only be assured by 25(OH) D (calcidiol) levels.
Dr. Cornelison seems to be unaware that diet, without sunlight, can rarely
supply adequate vitamin D and that one multivitamin (400 IU of vitamin D) a
day, without sunlight, will actually ensure vitamin D deficiency.
Just like an anesthesiologist, who assumes responsibility the airway on the
patient she intubates, dermatologists who tell patients to totally avoid the
sun, assume responsibility for their patient?s vitamin D system. A number of
academic dermatologists have said just that. See if you can pick out the
following quote in the two references listed below: ?it would seem mandatory
to ensure an adequate vitamin D3 status if sun exposure were seriously
curtailed, certainly in relation to carcinoma of breast, prostate and colon and
probably also malignant melanoma.? Coming from an academic dermatology center,
it sounds like the kind of statement that juries take into account when trying
to decide the applicable Standards of Care.
References:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12174089&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12720576&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12520530&dopt=Abstract
Humans evolved naked in the sun and have lived most of our time on earth within
30 degrees of the equator. Clothes are a recent addition, as are the vitamin
D reducing effects of cities, indoor work, automobiles and sunblock. We will
ask one more question.
The majority of Americans have 25(OH)D (calcidiol) levels most similar to which
of the following groups:
A. Old World, non-human primates living in the wild.
B. New World non-human primates living in the wild.
C. Modern day agricultural humans living near the equator.
D. Modern day humans spending some of their time in a natural state
(lifeguards).
E. Lab rats.
You guessed it!
THE VITAMIN D SCIENTISTS LISTED BELOW ARE WRITING AND SPEAKING OUT ABOUT THE
PROBLEM OF VITAMIN D DEFICIENCY. ALL ARE WILLING TO SPEAK WITH THE PRESS.
NONE ARE MEMBERS OF THE VITAMIN D COUNCIL.
William Grant, PhD
(Epidemiology)
12 Sir Francis Wyatt Place
Newport News, VA 23606-3660
Phone: (757) 599-9811
Email: wbgrant@xxxxxxxxxxxxxx
Robert Heaney, MD
Osteoporosis Research Center
Department of Medicine
Creighton University Medical Center
Omaha, NE 68131
Phone: (402) 280-4029
Email: rheaney@xxxxxxxxxxxxx
Michael Holick, PhD, MD
Vitamin D Laboratory
Department of Medicine
Boston University Medical Center
715 Albany St. M-1022
Boston, MA 02118
Phone (617) 638-4545
Fax 617-638-8882
Email: mfholick@xxxxxx
Bruce Hollis, PhD
Departments of Pediatrics
Medical University of South Carolina
171 Ashley Ave.
Charleston, SC 29425
Phone (843) 792-6854
Fax (843)792-8801
Email: Hollisb@xxxxxxxx
Christel Lamberg-Allardt, PhD
University of Helsinki,
Department of Applied Chemistry and Microbiology
P.O.Box 27, FIN-00014
University of Helsinki
Finland
Phone: (358) 9-1-915-8266
Fax: (358) 9-1-915-8475
Email: christel.lamberg-allardt@xxxxxxxxxxx
Tony Norman, PhD
Department of Biochemistry
Room 5456 Boyce Hall
University of California
Riverside, CA 92521
Phone: (909) 787-4777
Fax: (909) 787-4784
Email: anthony.norman@xxxxxxx
Reinhold Vieth, PhD
Pathology and Laboratory Medicine
Mount Sinai Hospital
600 University Ave.
Toronto, Ontario, Canada, M5G 1X5
Phone (416) 586-5920
Fax (416) 586-8628
Email: rvieth@xxxxxxxxxxxxx
ABOUT VITAMIN D:
Vitamin D is a vital nutrient that is unique, both in terms of its physiology
and because humans rely on both endogenous skin production and exogenous
sources to meet biological requirements. Vitamin D is commercially available
as vitamin D2, (ergocalciferol) made from plant products, and vitamin D3,
(cholecalciferol) made from animal products. Cholecalciferol is also made
naturally in the skin by the action of a specific wavelength of ultraviolet
light (UVB) interacting with precholesterol. Cholecalciferol is then
transported to the liver and turned into calcidiol [(25-hydroxyvitamin D].
Recent evidence indicates calcidiol [(25-hydroxyvitamin D] has steroid hormone
functionality. In turn, the calcidiol [25-hydroxyvitamin D] is transported to
the kidney and transformed into a more potent steroid, calcitriol
[1,25-dihydroxyvitamin D], which is excreted into the blood to help regulate
calcium in the body. This is the main endocrine function of vitamin D.
Meanwhile, many tissues other than the kidney turn calcidiol [25-hydroxyvitamin
D] into calcitriol [1,25-dihydroxyvitamin D]. Calcitriol
[1,25-dihydroxyvitamin D], and perhaps calcidiol [25-hydroxyvitamin D], help
regulate gene expression locally; this is the newly discovered autocrine
(inside the cell) and paracrine (surrounding the cell) functions of vitamin D.
This autocrine and paracrine function is impaired in vitamin D deficient
subjects. All studies show many Americans are vitamin D deficient, especially
Blacks, where the problem is pandemic. This use of calcitriol (and perhaps
calcidiol) by other tissues as an autocrine and paracrine hormone is a
relatively new discovery that explains its role in human development as well as
the many health benefits of vitamin D in other illnesses such as diabetes,
hypertension, heart disease, autoimmune illness, at least 13 different cancers
and, perhaps, some mental illness.
The single most important scientific fact about vitamin D is that young adult
Whites make about twenty thousand units of cholecalciferol in their skin within
minutes of whole-body, summer-sun exposure. This is one-hundred times the
Adequate Intake (AI) and five times the toxicity maximums (Lowest Observed
Adverse Effects Level or LOAEL) recommended by the Institute of Medicine (IOM)
for young adults. Therefore, many Americans greatly exceed the IOM?s safety
recommendations by simply spending a few minutes outside in their swimming
suits! This extraordinary rate of natural vitamin D production in the
skin(20,000 IU) leading to the production of potent endocrine, paracrine and
autocrine steroid hormones leads one (as T.S. Eliot once said), ?to an
overwhelming question.? Why did Nature design such a complex steroid system
reliant on rapid and bountiful production of cholecalciferol in the skin?
Answer,? Probably for a very good reason.?
Because low calcidiol [25-hydroxyvitamin D] levels (< 35 ng/ml) are associated
with so many chronic illnesses, calcidiol [25-hydroxyvitamin D] levels are an
important part of any laboratory health evaluation and should be routinely
checked by physicians. Holick recommends they be checked every year,
preferably in the fall. We recommend they be obtained twice a year, once in
late October and again in early April, depending on latitude, in order to
obtain both peak and valley levels. Unfortunately, few physicians are aware of
the vitamin D deficiency pandemic, so virtually no patients have their levels
checked. Consequently, perhaps as many as 70% of the U.S. population has
calcidiol [25-hydroxyvitamin D] levels below 35 ng/ml. Even when asked to
check vitamin D levels, physicians often order calcitriol
[1,25-dihydroxyvitamin D] levels, instead of calcidiol [25-hydroxyvitamin D]
levels, an error which greatly misleads both the physician and the patient.
For numerous reasons (optimal calcium absorption, maximal suppression of PTH,
reduction in blood pressure, decreased incidence of various cancers, retarding
the progression of osteoarthritis, reducing sarcopenia (muscle wasting),
reducing the incidence of autoimmune illness, reduction in CRP, etc), healthful
blood levels of calcidiol [25-hydroxyvitamin D] are between 35 and 55ng/ml
although commercial labs usually report ?normal? or Gaussian distributions of
between 8-72 ng/ml depending on the latitude of the lab?s population.
Therefore, commercial reference laboratories also mislead physicians and their
patients by reporting ?normal? (Gaussian) distributions of a deficient
population instead of healthful calcidiol [25-hydroxyvitamin D] levels.
Patients need to know these facts before asking their physician for the
calcidiol [25-hydroxyvitamin D] blood test. Until the medical profession
becomes knowledgeable on this matter, patients need to become educated, educate
their !
physicians, get the proper blood test and then take steps to raise their
calcidiol [25-hydroxyvitamin D] level if it is less than 35 ng/ml. We know of
no good reason to exceed 50ng/ml. Documented toxicity may start at around 80
ng/ml (200 nm/L), but that would require chronic sustained input from all
sources of more than 20,000 IU per day.
Populations around the equator (where man evolved) and groups spending time
outdoors without many clothes (lifeguards), have levels of around 50ng/ml. Such
observations have important implications for the vitamin D conditions under
which humans evolved. In other words, it suggests humans have had
25-hydroxyvitamin D levels of around 50 ng/ml for 99.99 % of the time they have
been on earth. Only in the last several hundred years has urbanization,
industrialization, glass (UVB does not penetrate glass), excessive clothes (UVB
does not penetrate clothes), sunblock and medical advice to completely avoid
sunlight lowered 25-hydroxyvitamin D levels to their currently deficient
levels.
Persons with low levels have three choices: the sun, a low-pressure sunlamp or
vitamin D supplements. One cannot obtain adequate vitamin D from food unless
one regularly eats very large quantities of oily fish. Milk is supposed to
have 100 IU of vitamin D a glass but often contains less. Contrary to popular
belief, most other dairy products have none.
At most latitudes in the USA, little or no vitamin D is made in the skin in the
late fall and early winter. In northern states, the vitamin D blackout lasts
for almost six months. In the spring and summer, young Whites can make large
amounts (20,000 IU) by sunbathing on both sides, without sunblock, for a few
minutes (about 1/2 the time it takes for the skin to begin to slightly redden).
UVB meters can be most helpful in determining if there is sufficient UVB in
the sunlight at your latitude, season and time of day,
(http://www.solarmeter.com/model6.html). Older person need longer exposure and
do not have the robust abilities of the young but can still make 8,000 IU in a
single full body exposure. Darker skinned persons need 5 to 10 times longer
depending on the amount of melanin pigment in the skin. Vitamin D production
occurs within minutes and is maximized long before the skin turns red or begins
to tan. One does not have to worry about toxicity or get repeated bloo!
d tests when using sun exposure to obtain vitamin D. Toxicity cannot occur
even with heavy and continuous sunbathing because ultraviolet light begins to
degrade vitamin D in the skin after making about 20,000 IU, thus reaching sated
state. Overexposure, especially sunburns, is damaging to the skin, dangerous,
and should be entirely avoided.
Some artificial low-pressure sun lamps contain significant amounts of UVB and
raise calcidiol [25-hydroxyvitamin D] levels into the healthful range. Just
like the sun, one does not have to worry about toxicity or obtain repeated
blood levels, when using them. However, just like the sun, care must be taken
not to overexpose the skin. Suntans are not needed to obtain adequate vitamin
D. Sunburns must be avoided. One manufacturer with some vitamin D data is
Sperti: http://www.sperti.com/products.htm.
Many people are beginning to rely on supplements to raise their calcidiol
[25-hydroxyvitamin D] levels as they have been told (usually erroneously) to
entirely avoid any sunlight. (Totally avoiding the sun and supplementing with
vitamin D assumes that the only benefit of sunlight is vitamin D, which is a
premature and potentially dangerous assumption). In the complete absence of
UVB, one must consume 3,000 to 5,000 IU of cholecalciferol a day to maintain
healthful calcidiol [25-hydroxyvitamin D] levels. Similar studies have not
been done with ergocalciferol but current data indicates that almost twice as
much ergocalciferol would be needed. Vitamin D repletion is safest when done
under a physician?s care so calcidiol [25-hydroxyvitaminD] levels (and perhaps
calcium levels) can be monitored. Persons diagnosed with sarcoidosis, other
granulomatous disease, cancer (especially lymphoma) or hyperparathyroidism
should not take vitamin D unless they are under the care of a know!
ledgeable physician (and would be well advised to find one). Patients with
these conditions may develop a vitamin D hypersensitivity syndrome, which is
different from vitamin D toxicity.
Persons who do not want to have blood tests would be best advised to rely on
prudent sun exposure. If such persons choose to avoid the sun, they should
never exceed 2,000 IU of cholecalciferol a day [which is the Institute of
Medicine?s NOAEL (No Observed Adverse Effects Level)].
Cholecalciferol can be obtained at health food stores and on the internet.
Ergocalciferol can be obtained in 25,000 and 50,000 IU doses via prescription
from your doctor. We obtain pharmaceutical grade 1,000 IU capsules of
cholecalciferol made by Roche from the Life Extension Foundation:
(http://www.lef.org/newshop/items/item00251.html). Cod liver oil contains
about 1200 IU of vitamin D per tablespoon but also may contain about 14,000 IU
of vitamin. Therefore, persons with no sun exposure may exceed safe intakes of
vitamin A in order to replete the vitamin D system. (We know omega-3 nutrition
is very important but believe fish oil to be a safer alternative than cod liver
oil).
Vitamin D can be toxic in overdose (more than 40,000 IU a day over several
months). Virtually all the toxicity reports in the literature are iatrogenic:
large doses of ergocalciferol prescribed for medical reasons (usually
hypoparathyroidism or osteoporosis). We are not aware of any reports in the
literature of deaths from acute overdose, such as murder or suicide. In fact, a
150-pound human would have to take more than 100,000 capsules of the 1,000 IU
cholecalciferol capsules to approach the LD50 for the most sensitive mammal
(the male rat at 40 mg/kg). Such patients would be more likely to die from
gastric bloating leading to asphyxiation than from vitamin D toxicity. In
mammals, signs of toxicity short of death can first be seen at.5mg/kg (20,000
IU/kg or 1,400 capsules at one time for a 150-pound adult human). We are
unaware of any reports of vitamin D toxicity from cholecalciferol supplements
except when manufacturing errors occurred. Most of the reported toxicity i!
s industrial (dairies putting in the wrong amount into milk or the concentrated
oil being used for cooking). However, death from chronic poisoning has been
described and is possible. If you believe ?a little is good then a whole lot
is better,? then you may prove an association between judgment and Natural
Selection.
LEGAL ASPECTS:
To date, we know of no physician who has had a malpractice action filed against
him for failure to diagnose or treat vitamin D deficiency. We are not aware of
a single dermatologist held liable for telling a patient to totally avoid the
sun (without taking care to monitor their calcidiol [25(OH)D] levels), no
matter how many vitamin D deficiency associated diseases that patient
subsequently develops. However, commercial reference labs that mislead
physicians with outdated ?normal? distribution levels (Gaussian distributions
of deficient populations), instead of healthful or ideal calcidiol [(25(OH)D]
levels, do have obvious liability exposure as do dermatologists who assume
control of the vitamin D system via their sun-abstinence advice. The Vitamin D
Council has attempted to educate, via registered letter, the American Board of
Pathology as well as the five largest commercial reference labs in the USA
about the danger of misleading 25(OH)D reporting methods and the damage!
those misleading reports may engender. We plan additional such educational
activities directed at the American Academy of Dermatology.
Things change quickly in tort law; as soon as readers know of any vitamin D
cases, we would like to hear about them. Current medical journals are full of
dire warnings by the top experts. As unfair as such suits would seem to
practicing physicians, we believe continued suffering from undiagnosed and
untreated vitamin D deficiency is more unfair. The Vitamin D Council feels
malpractice suits are inevitable and, no matter how disquieting, will herald
the end to death and disability due to undiagnosed and untreated vitamin D
deficiency.
Remember, losing a malpractice case requires that only a preponderance of
evidence (51%) was against you, not proof beyond a reasonable doubt.
Scientific proof is not required, only opinions by medical experts that meet
the legal (Daubert) standards for experts. Some physicians also mistakenly
think standard care is the same as Standard of Care; they are not and never
have been. Standard care is what most doctors do, Standard of Care is what one
jury thought one physician should have done with one patient at particular time
in one particular jurisdiction. Most importantly, Standards of Care are never
determined by the Institute of Medicine, the Food and Nutrition Board, the
National Institute of Health, the American Medical Association, practice
guidelines, your supervisor, your Chief of Staff, your colleagues or this
publication. Standards of Care are only determined by triers of fact (judges
or juries) after listening to testimony of experts whose credentials are vet!
ted by the court.
ABOUT THE VITAMIN D COUNCIL:
The Vitamin D Council is a group of citizens concerned about vitamin D
deficiency and the diseases associated with that deficiency. We have recently
changed our name from The Cholecalciferol Council to the Vitamin D Council.
The Vitamin D Council will attempt to draw attention to the problem of vitamin
D deficiency through the education of professionals, the media, government
officials and average citizens. Our immediate goal is to fund our non-profit
corporation. The Vitamin D Council?s long-range goal is to end the needless
suffering and death from vitamin D deficiency. Our initial campaign will center
on enabling the Institute of Medicine?s Food and Nutrition Board to reconvene
an expert panel on vitamin D nutrition so they can update their recommendations
on vitamin D to make it current with today?s science. We also hope to secure a
grant to allow us to publish an academic journal on Vitamin D, contracting with
one the scientists below to serve as executive editor an!
d others to serve as associate editors. We would then offer subscriptions to
the academic community, including readers of this newsletter. However, the
Vitamin newsletter you are currently reading will remain separate from the
proposed academic journal and will remain free for the foreseeable future.
The Vitamin D Council is a nonprofit entity incorporated under the laws of
California under the name Cholecalciferol Council. We are a now a tax-exempt,
non-profit[501(c)(3)] educational organization under the laws the United
States. We currently have no funding but will soon apply for grants as our
[501(c)(3)] status was recently granted. We will not accept donations or
grants from individuals or organizations whose goals may conflict with ours.
Particularly, we will not accept any donations from the American Trial Lawyers
Association or groups that represent them. The president of the Vitamin D
Council is John Jacob Cannell, MD, the vice-president is Tatiana Cannell, MD,
the secretary is Olga Cebanova, MD, MD, and the treasurer is Andrei Gutsu, MD.
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