Vitamin D keeps getting more and more respect. While planning to write here about it for those of us with diabetes, I gathered reports for the past year about its value in treating many conditions.Vitamin D helps all of us to maintain normal blood levels of calcium and phosphorus. By promoting calc...
How Much Vitamin D?
1/24/07 4:48am
David, could you expand on the different forms of Vitamin D, and their potency, please?
6/ 2/07 12:01am
Peggy L Manuel, MD, FAAP, asked us months ago to post this comment. But through a mix-up (and change of staff), it didn't happen. She kindly reminded me again this evening:
Hello, David. I would like to expand on the vitamin D2 (ergocalciferol or ergosterol) vs D3 (cholecalciferol) please. I think it is extremely important to use only the D3 if possible for several reasons (unless you are a strict vegetarian). Some report that the D3 works about 3x better than the D2, and very large doses of D2 can lead to overdosing about 10x more easily than D3. Apparently D3 binds to the vitamin D binding protein about 10x better than the D2 (which acts like a reservoir, bound until needed). So, D3 is safer and also more potent! I am sending you text from a pretty good website (with references). I found it ironic that cholesterol is a precursor to vitamin D, and that lard is a good source (if the pig got sunshine), in addition to cod liver oil, sockeye salmon (680IU/4oz), herring, oysters, catfish, etc. Statins may inhibit the production of vitamin D, as well as reducing Co-enzyme Q, so more studies need to done long term. It is exciting to see more research clarifying the important roles of vitamin D.
Thanks for getting the word out. Take care, Peggy L Manuel, MD, FAAP
PS Most researchers are starting to recommend 1,000IU daily for 2 yr and up; for adults 2,000IU winters or 3,000IU if overweight, dark-skinned, pregnant or breast-feeding. I now increase my dose to 5000 IU for 3 days when I get sick, since vitamin D seems to strengthen the immune system. Your blog may wish to clarify that 400IU for milk is for 32oz. Also, another contraindication to vitamin D supplementation of any kind may be sarcoidosis. Apparently the granulomatous tissue in the lungs may actually produce vitamin D and can lead to toxicity.
http://www.cholesterol-and-health.com/Vitamin-D.html "Vitamin D is carried in the blood by vitamin D-binding protein (DBP). DBP is kind of like a savings account for vitamin D. If you didn't have the DBP, you'd be forced to use all your vitamin D as soon as you absorb it, and excrete the rest. This would be a giant waste of vitamin D, because you can only use so much at a time. DBP thus helps to increase the effect of a given dose of vitamin D by holding on to what you don't need at any given moment for later use, and helps prevent toxicity by keeping the portion you don't need at any given moment from being delivered to your cells.2
Although vitamin D2 binds well to the vitamin D receptor, it has very little affinity for vitamin D-binding protein. For this reason, it is well-known to be useless in chickens and other birds. When vitamin D was seen merely as a cure for rickets, vitamin D2's ability to treat rickets in the small amounts needed led researchers to believe it equal in power to vitamin D3 in humans. Now that researchers are uncovering the need for much higher levels of vitamin D to maintain optimal health, it is becoming clear that vitamin D2 just doesn't fit the bill.
The researchers Laura Armas, Bruce Hollis, and Robert Heaney showed in 2004 that vitamin D2's low affinity for the vitamin D-binding protein makes it nearly ten times less effective at raising long-term vitamin D levels.9
If vitamin D2 has a lower affinity for the DBP, it follows that it is also much more likely to result in toxicity than is vitamin D3. It is therefore unsurprising that, according to Dr. John Cannel, president of the Vitamin D Council, nearly all cases of toxicity from pharmacological doses of vitamin D resulted from the consumption of vitamin D2.10
The vitamin D2 synthesized from plant sterols should therefore not be considered true vitamin D for humans. Humans should obtain vitamin D from the sun and from the vitamin D-rich fatty animal foods that provide the form of vitamin D with which the sun provides us, and which we have consumed throughout our evolution...."
"...2. Adams and Hollis, “Vitamin D: Synthesis, Metabolism, and Clinical Measurement.” In: Coe and Favus, eds., Disorders of Bone and Mineral Metabolism, Philadelphia: Lippincott Williams and Wilkins (2002) p. 159.
9. Armas, et al., “Vitamin D2 Is Much Less Effective than Vitamin D3 in Humans,” The Journal of Clinical Endocrinology and Metabolism, Vol. 89 No. 11 (2004) 5387-5391.
10. Cannel, MD, John Jacob, "The Truth About Vitamin D Toxicity," http://www.vitamindcouncil.com/vitaminDToxicity.shtml. Published September 4, 2003. Accessed May 24, 2006."
How Much Vitamin D? Vitamin D seems to protect us from many problems. But until now the real question was how much that we can safely take. A new study goes a long way toward answering this question.
Hello, David. I would like to expand on the vitamin D2 (ergocalciferol or ergosterol) vs D3 (cholecalciferol) please. I think it is extremely important to use only the D3 if possible for several reasons (unless you are a strict vegetarian). Some report that the D3 works about 3x better than the D2, and very large doses of D2 can lead to overdosing about 10x more easily than D3. Apparently D3 binds to the vitamin D binding protein about 10x better than the D2 (which acts like a reservoir, bound until needed). So, D3 is safer and also more potent! I am sending you text from a pretty good website (with references). I found it ironic that cholesterol is a precursor to vitamin D, and that lard is a good source (if the pig got sunshine), in addition to cod liver oil, sockeye salmon (680IU/4oz), herring, oysters, catfish, etc. Statins may inhibit the production of vitamin D, as well as reducing Co-enzyme Q, so more studies need to done long term. It is exciting to see more research clarifying the important roles of vitamin D.
Thanks for getting the word out. Take care, Peggy L Manuel, MD, FAAP
PS Most researchers are starting to recommend 1,000IU daily for 2 yr and up; for adults 2,000IU winters or 3,000IU if overweight, dark-skinned, pregnant or breast-feeding. I now increase my dose to 5000 IU for 3 days when I get sick, since vitamin D seems to strengthen the immune system. Your blog may wish to clarify that 400IU for milk is for 32oz. Also, another contraindication to vitamin D supplementation of any kind may be sarcoidosis. Apparently the granulomatous tissue in the lungs may actually produce vitamin D and can lead to toxicity.
http://www.cholesterol-and-health.com/Vitamin-D.html "Vitamin D is carried in the blood by vitamin D-binding protein (DBP). DBP is kind of like a savings account for vitamin D. If you didn't have the DBP, you'd be forced to use all your vitamin D as soon as you absorb it, and excrete the rest. This would be a giant waste of vitamin D, because you can only use so much at a time. DBP thus helps to increase the effect of a given dose of vitamin D by holding on to what you don't need at any given moment for later use, and helps prevent toxicity by keeping the portion you don't need at any given moment from being delivered to your cells.2
Although vitamin D2 binds well to the vitamin D receptor, it has very little affinity for vitamin D-binding protein. For this reason, it is well-known to be useless in chickens and other birds. When vitamin D was seen merely as a cure for rickets, vitamin D2's ability to treat rickets in the small amounts needed led researchers to believe it equal in power to vitamin D3 in humans. Now that researchers are uncovering the need for much higher levels of vitamin D to maintain optimal health, it is becoming clear that vitamin D2 just doesn't fit the bill.
The researchers Laura Armas, Bruce Hollis, and Robert Heaney showed in 2004 that vitamin D2's low affinity for the vitamin D-binding protein makes it nearly ten times less effective at raising long-term vitamin D levels.9
If vitamin D2 has a lower affinity for the DBP, it follows that it is also much more likely to result in toxicity than is vitamin D3. It is therefore unsurprising that, according to Dr. John Cannel, president of the Vitamin D Council, nearly all cases of toxicity from pharmacological doses of vitamin D resulted from the consumption of vitamin D2.10
The vitamin D2 synthesized from plant sterols should therefore not be considered true vitamin D for humans. Humans should obtain vitamin D from the sun and from the vitamin D-rich fatty animal foods that provide the form of vitamin D with which the sun provides us, and which we have consumed throughout our evolution...."
"...2. Adams and Hollis, “Vitamin D: Synthesis, Metabolism, and Clinical Measurement.” In: Coe and Favus, eds., Disorders of Bone and Mineral Metabolism, Philadelphia: Lippincott Williams and Wilkins (2002) p. 159.
9. Armas, et al., “Vitamin D2 Is Much Less Effective than Vitamin D3 in Humans,” The Journal of Clinical Endocrinology and Metabolism, Vol. 89 No. 11 (2004) 5387-5391.
10. Cannel, MD, John Jacob, "The Truth About Vitamin D Toxicity," http://www.vitamindcouncil.com/vitaminDToxicity.shtml. Published September 4, 2003. Accessed May 24, 2006."
How Much Vitamin D? Vitamin D seems to protect us from many problems. But until now the real question was how much that we can safely take. A new study goes a long way toward answering this question.
11/26/08 1:53am
I just reread this article and after much investigation and advice of my MD I am taking 50,000 units of Vit D a day. I was taking 10,000 a day but have up it to 50k recently. I feel excellent, my diabetes is under control thu use of Byetta and I believe that Vit D is an essential element in my return to health, so does my physician. Ballot
12/14/08 2:45pm
May I suggest that anyone considering supplementing at 50,000iu/daily gets a 25(OH)D test regularly. Naturally regular full body sun exposure leads to the body attaining and maintaining a 25(OH)D around 125~175ng/ml or 50~70ng/ml generally speaking 1000iu/daily per 25lbs will achieve that sort of level averaging 5000iu/daily for a woman or 6000iu/d for a man. Heaney has shown our bodies can manage with 3000~5000iu so long term supplementation with amount around 50,000iu may lead to adverse events when status gets over 325nmol/l 130ng. It will take many months for the average person to reach that status. The usual way to restore someone with Vitamin D insufficiency is to use ONE 50,000iu capsule EACH WEEK for a total of EIGHT weeks, not one capsule of this size daily.
In the UK a 25(OH)D Diasorin test can be found for £40 so it's not overly expensive to get a test done to check that a level of 60ng 150nmol/l had been attained after several months supplementing at effective levels or in this case as soon as possible.
12/14/08 4:21pm
Very good suggestion. I have my vit d levels checked about every 3 months. I am due for labs next week. I will make sure the Vit D is included. I will let you know the results as soon as I know them. Thanks for the heads up and I appreciate your interest. My MD has had extensive experience with vit d using it in over 500 persons with diabetes. I know he is concerned too and likes to see the tests. He feels that we have just begun to understand how helpful Vit d can be in human health and healing.
1/19/09 6:22pm
What do you think of this opinion of the issue of D supplementation? It could be that low D levels are the symptom, and not the "disease" itself.
Vitamin D Deficiency Study Raises New Questions About Disease And Supplements
ScienceDaily (Jan. 27, 2008) - Low blood levels of vitamin D have long been associated with disease, and the assumption has been that vitamin D supplements may protect against disease. However, this new research demonstrates that ingested vitamin D is immunosuppressive and that low blood levels of vitamin D may be actually a result of the disease process. Supplementation may make the disease worse.
In a new report Trevor Marshall, Ph.D., professor at Australia's Murdoch University School of Biological Medicine and Biotechnology, explains how increased vitamin D intake affects much more than just nutrition or bone health. The paper explains how the Vitamin D Nuclear Receptor (VDR) acts in the repression or transcription of hundreds of genes, including genes associated with diseases ranging from cancers to multiple sclerosis.
"The VDR is at the heart of innate immunity, being responsible for expression of most of the antimicrobial peptides, which are the body's ultimate response to infection," Marshall said.
"Molecular biology is now forcing us to re-think the idea that a low measured value of vitamin D means we simply must add more to our diet. Supplemental vitamin D has been used for decades, and yet the epidemics of chronic disease, such as heart disease and obesity, are just getting worse."
"Our disease model has shown us why low levels of vitamin D are observed in association with major and chronic illness," Marshall added. "Vitamin D is a secosteroid hormone, and the body regulates the production of all it needs. In fact, the use of supplements can be harmful, because they suppress the immune system so that the body cannot fight disease and infection effectively."
Marshall's research has demonstrated how ingested vitamin D can actually block VDR activation, the opposite effect to that of Sunshine. Instead of a positive effect on gene expression, Marshall reported that his own work, as well as the work of others, shows that quite nominal doses of ingested vitamin D can suppress the proper operation of the immune system. It is a different metabolite, a secosteroid hormone called 1,25-dihydroxyvitamin D, which activates the VDR to regulate the expression of the genes. Under conditions that exist in infection or inflammation, the body automatically regulates its production of all the vitamin D metabolites, including 25-hydroxyvitamin D, the metabolite which is usually measured to indicate vitamin D status.
Vitamin D deficiency, long interpreted as a cause of disease, is more likely the result of the disease process, and increasing intake of vitamin D often makes the disease worse. "Dysregulation of vitamin D has been observed in many chronic diseases, including many thought to be autoimmune," said J.C. Waterhouse, Ph.D., lead author of a book chapter on vitamin D and chronic disease.
"We have found that vitamin D supplementation, even at levels many consider desirable, interferes with recovery in these patients."
"We need to discard the notion that vitamin D affects a disease state in a simple way," Marshall said. "Vitamin D affects the expression of over 1,000 genes, so we should not expect a simplistic cause and effect between vitamin D supplementation and disease. The comprehensive studies are just not showing that supplementary vitamin D makes people healthier."
Journal reference: Marshall TG. Vitamin D discovery outpaces FDA decision making. Bioessays. 2008 Jan 15;30(2):173-182 [Epub ahead of print] Online ISSN: 1521-1878 Print ISSN: 0265-9247 PMID: 18200565
1/19/09 8:58pm
1/20/09 11:38am
It is reassuring to hear that, because my daughter's doctor has her on a very high dose of D right now (her levels were quite low). I, too, have been taking extra D, but wasn't sure that was a good thing after reading that.
Just in general, I get depressed from trying to figure the best course of action for any kind of health issue after reading the conflicting views on everything. They say a little knowledge is a dangerous thing, so perhaps that is my problem. :-)
For example, I have tried to eat low carb, but have been unsuccesful at sticking with it. I have considered going to Weight Watchers, because my siser-in-law is doing well at that and claims she feels good, too. But... but, I am terrified of carbs and wonder, even if a diabetic (or person with that tendency) is losing weight, is it possible that damage is still being done? If a diabetic is eating carbs, is he still wearing out his beta cells? On the other side, there is a lot out there saying that extremely low carb diets are unhealthy. (I've been reading some studies published in the journal Obesity.) Neither side will budge. It's enough to drive a person to the dessert table!
It's very discouraging. I don't even feel like trying even though I know what will happen to me down the road if I don't do something.
Also, I am a diabetes medication skeptic, so that is out of the question. I think meds just treat the symptoms and do nothing to halt the progress of the disease or prevent complications. The drug companies' emphasis on "treating the numbers" is a result of massaging the data on the large diabes trials done in the past. Perhaps it would take too many years, but any study done of a diabetes medication should focus on the prevention of complications, not just on how well it lowers BG numbers.
Thanks for listening.
1/20/09 2:54pm
Dear Aggie,
We are living in interesting times. Part of what makes this time interesting is because of all the uncertainty. Not only do we not know what is going to happen tomorrow or next year but we don't even know what we really need to know to take care of our own bodies. But we have to act, and we have to act on incomplete knowledge.
Personally, I find this uncertainty to be a lot more stimulating than having to learn by rote. I often think of the stupid way that the course in bacteriology was presented to me as a freshman in college. I found it incredibly dull because the professor just wanted us to take in the received knowledge. That turned me away from science in college. Little did I know -- or did the professor know -- what an explosion of scientific knowledge was coming -- and continues to come even now.
This uncertainty forces us to think for ourselves, applying strategies that work. This pragmatism is truly American and reminds me of the wise words of President Obama this morning that we can no longer argue over whether our government is too big or too small. What works is right for our government and for our bodies.
More concretely, I'm struck by your comment that a low carb diet didn't work for you. I'm not sure, of course, how many grams of carbs you consumed. But I absolutely know that a low-carb diet doesn't work. Only a very low-carb diet will work. I mean on the order of 40 or 50 grams of carbohydrate per day. That has worked for thousands of patients of Drs. Bernstein and Eades and I know personally that it works.
Best regards,
David
1/23/09 7:46pm
1/23/09 8:44pm
Dear Aggie,
I certainly understand. It is indeed hard to start on a low-carb diet.
But Byetta is a great alternative. It certainly worked for me to control my blood glucose and my weight. Then, when I didn't want to have to take any medication any more, it was much easier to switch to a very low-carb diet.
Best regards,
David
1/21/09 5:38pm
Hello I have been taking 50.000 unit of V. D for over a year now and my levels still have not improves enough. now my doctor Say's add 1,000 unit more a DAY. I have Hypo Gamma Globulinemia (functional) so I Subq antibodies every day I not sure if this has anything to do with the lack of Vitamin D. Know body seems to know or really care.
2/ 3/09 8:54am
My Chiropractor/nutritionist helped me a lot when my blood calcium was running high and at the same time I couldn't take being out in the heat. He explained that the vit D is important in getting the Calcium from our gut into our blood stream...but we need the "good" fats (like fish oil & olive oil) to get it from our blood stream into our muscles and bones, etc. After I increased these "good" fats, my blood calcium leveled out and being out in the sun doesn't bother more than normal now.
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