Time for some continuing education and another quiz!
1) Most of the infants born in the northern half of the US are at
risk for rickets, especially if they are breast-fed.
True. Dr. Joyce
Lee, at the University of Michigan, has recently confirmed that both
newborn infants and their mothers in Boston are
severely vitamin D deficient. Fifty percent of the mothers and 65%
of the infants had vitamin D blood levels below 12 ng/ml (30 nmol/L),
which is low enough to cause rickets in the infants and osteomalacia
(adult rickets) in the mothers. Healthy levels are at least 40 ng/ml.
Lee JM, et al. Vitamin D deficiency in a healthy
group of mothers and newborn
infants. Clin Pediatr. (Phila). 2007
Make no mistake, rickets is a serious problem in the US, even in the
summer. This disease of the industrial revolution is getting to be
a common problem
in African-American infants. Ironically, the incidence is higher in infants
who consume the Zion of nature's perfect food, breast milk.
Weisberg P, Scanlon KS, Li R, Cogswell ME. Nutritional rickets among children
in the United States: review of cases reported between 1986 and 2003. Am
J Clin Nutr. 2004 Dec;80(6 Suppl):1697S-705S.
Ziegler EE, et al. Vitamin D deficiency in breastfed infants in Iowa. Pediatrics. 2006
It's not just rickets these breast-fed infants must contend with, but
seizures and heart failure as well, both of which can be fatal.
Alouf B, Grigalonis M. Incidental finding of vitamin-D
deficient rickets in an otherwise healthy infant – a reappraisal of current
vitamin-D supplementation guidelines. J Natl Med Assoc.
Ashraf A, et al. Prevalence of hypovitaminosis D in early infantile hypocalcemia.
J Pediatr Endocrinol Metab. 2006 Aug;19(8):1025-31.
Balasubramanian S, Shivbalan S, Kumar PS. Hypocalcemia due to vitamin D deficiency
in exclusively breastfed infants. Indian Pediatr. 2006
Bloom E, et al. Variable presentations of rickets in children in the emergency
department. Pediatr Emerg Care. 2004 Feb;20(2):126-30.
Cramm KJ, Cattaneo RA, Schremmer RD. An infant with tachypnea. Pediatr
Emerg Care. 2006 Nov;22(11):728-31.
It's not just infants who are having seizures and breaking their
bones. A 17-year-old New Yorker had a seizure from low blood calcium
caused by vitamin
D deficiency; the seizures broke the necks of both of his femurs, usually
the strongest bones in the body.
Schnadower D, et al. Hypocalcemic seizures and secondary bilateral femoral
fractures in an adolescent with primary vitamin D deficiency. Pediatrics. 2006
The reason breast-feeding (still the best way to feed an infant) is a risk
factor for infantile rickets, seizures, and heart failure is that breast
milk, like any milk, is only as nutritious as the mother who produces it.
mothers are vitamin D deficient – in spite of their consumption of multivitamins
and vitamin D fortified cow's milk – breast milk is a poor source
of vitamin D. Even mothers who go into the sun will have deficient breast
milk in the winter in northern latitudes. However, as Bruce Hollis and Carol
showed several years ago, mothers who take 4,000 IU of vitamin D daily can
safely breast-feed their infant without concern their baby will develop any
of these medieval diseases.
Hollis BW, Wagner CL. Vitamin D requirements during lactation: high-dose
maternal supplementation as therapy to prevent hypovitaminosis D for both
and the nursing infant. Am J Clin Nutr. 2004
Furthermore, it is time to shed a tear for mothers, especially African-American
mothers, who followed La Leche League's advice to breast-feed their infants
without taking vitamin D supplements. These mothers were dedicated enough
to breast-feed and concerned enough to bring their child to an emergency
when their child's bone's started to break – only to be unjustly
accused of child abuse. "By the rivers of Babylon, there we sat down,
yea, we wept, when we remembered Zion."
Bloom E, et al. Variable presentations of rickets in children in the emergency
department. Pediatr Emerg Care. 2004 Feb;20(2):126-30.
Paterson CR. Vitamin D deficiency rickets simulating child abuse. J
Pediatr Orthop. 1981;1(4):423-5.
2) If you take a multivitamin and drink three glasses of milk a day,
but totally avoid direct sunlight, you will become vitamin D deficient.
The answer is false. I know several years
ago I said "true," but
research steadily goes on. Dr. Turnbull, working with Dr. Kimlin in
Australia, showed that UVB light in the shade is strong enough to activate
vitamin D production in the skin. Think of UVB as a ping-pong ball.
It bounces off lots of things. When you go into the sun – if
the sun is high enough in the sky – UVB light comes through the
atmosphere and then starts bouncing around. It bounces at you from
the ground, buildings, cars, and even the bottom of clouds. Sitting
under a shade tree delivered about half as much UVB as sitting in the
direct sun. Furthermore, the damaging UVA radiation under direct sun
was three times more than under the shade tree. Sitting in the shade
in the summer (and the winter in subtropical and tropical latitudes)
is a good way to get vitamin D. You even get some in the car, as long
as the windows are down.
Turnbull DJ, Parisi AV, Kimlin MG. Vitamin D effective ultraviolet
wavelengths due to scattering in shade. J Steroid Biochem Mol
Biol. 2005 Sep;96(5):431-6.
3) The US Federal Government recommends you take a rat poison every
True, but they don't recommend enough.
Vitamin D has been used as a rat poison (rodenticide) for years.
However, as I said three years ago, it's the dose, the dose, the dose.
Humans would have to take tens of thousands of standard 1,000 IU vitamin D
capsules to risk chance of death from overdosage. With the 50,000 IU capsule,
this margin of safety is 50 times lower. Not one person has ever been reported
to have died from taking vitamin D supplements, unless they purchased low-quality
supplements that had hundreds of thousands times more vitamin D in them than
reported on the label. Not one person has ever been reported to have successfully
committed suicide with vitamin D. In fact, water is more toxic than vitamin
D. Not only are there more deaths – a lot more – from water intoxication
than from vitamin D intoxication, water has a lower therapeutic index (the
ratio of toxic to therapeutic doses). The words of the father of toxicology,
Paracelsus, ring true over the ages, "All things are poison and nothing
is without poison, only the dose permits something not to be poisonous."
4) In a recent study, HDL cholesterol (the good cholesterol) was strongly
associated with vitamin D blood levels.
True. The association was strong (P<.005) among 120 women with
polycystic ovarian disease. However, like dozens of other studies,
the authors also found a strong inverse correlation between obesity
and vitamin D levels – the higher the vitamin D levels, the thinner
the patients – and this may explain the association with HDL
cholesterol. Unfortunately, the authors did not look further at their
data to see if the association with HDL held after correction for body
Hahn S, et al. Low serum 25-hydroxyvitamin D concentrations are associated
with insulin resistance and obesity in women with polycystic ovary
syndrome. Exp Clin Endocrinol Diabetes.
5) People can reach 100 years of age without
any vitamin D in their blood.
True. When researchers went to an Italian
nursing home, they found that 99 of 104 residents had no detectable
vitamin D in their blood.
All the 104 residents were over 98 years old! But the key word is "can." Before
you stop your vitamin D so you can live to 98, know that the study
said nothing about what the residents' levels were before they
came to the nursing home. A recent large study showed good evidence
that low levels are not only associated with going into nursing homes,
but with dying as well.
Passeri G, et al. Low vitamin D status, high bone turnover, and bone
fractures in centenarians. J Clin Endocrinol Metab. 2003
Visser M, et al. Low serum concentrations of 25-hydroxyvitamin D in
older persons and the risk of nursing home admission. Am J Clin
2006 Sep;84(3):616-22; quiz 671-2.
6) Being in the sun helps protect you from being in the sun.
True. Dr. Dixon, at the University of
Sydney, working with Professor Rebecca Mason's group, has presented
additional evidence that vitamin D metabolites protect the skin from
sun damage and do so via
rapid acting pathways that do not involve genetic transcription. As
anyone who has ever taken 5,000 IU a day for several months can tell
you, your skin is much less likely to burn when you are no longer vitamin
Dixon KM, et al. In vivo relevance for photoprotection by the vitamin
D rapid response pathway. J Steroid Biochem Mol Biol. 2007
Jan 11; [Epub ahead of print]
7) It looks like vitamin D deficiency
is a major cause of Parkinson's
True. In an excellent paper, Drs. Harold
and Jonathan Newmark (father and son), present the considerable evidence
that vitamin D deficiency
is one cause, perhaps the major cause, of Parkinson's disease.
(Muhammad Ali has this disease, and, in his case, it may have been
caused by boxing. However, a lot of boxers never get Parkinson's
disease, and most people who have Parkinson's disease never boxed.)
Drs. Newmark remark on a 1997 case report in which a patient with Parkinson's
disease steadily improved when treated with 4,000 IU daily. However,
their recommendation for an interventional study using only 2,000 IU
daily in Parkinsonian patients is regrettable. Such a low dose in such
a severe disease may tragically miss a treatment effect and would only
have to be repeated in the future with physiological amounts of vitamin
D. All clinical interventional studies – in any disease – should
use enough vitamin D to obtain and then maintain blood levels at levels
obtained from natural summertime sun exposure (at least 50 ng/ml).
For many people – the aged, African-Americans, and the obese – this
requires 5,000 IU daily. If you know Muhammad Ali, or anyone with Parkinson's
disease, suggest they start taking 5,000 IU a day. If they or their
doctor are concerned about toxicity, have them read the literature.
If they can't do that, have the doctor measure their 25(OH)D
and calcium levels every four months. Both patient and doctor will
soon realize that 5,000 IU is a physiological dose.
Newmark HL, Newmark J. Vitamin D and Parkinson's disease-A hypothesis. Mov Disord. 2007 Jan 17; [Epub ahead
8) There were at least 100 courageous people in Boston in 1919.
True. Five controlled human studies were conducted on volunteers
in the desperate days of 1919 when 50,000,000 people in the world had
just died from influenza. All five attempted to show influenza is transmitted
like the common cold, from the sick to the well. It gave me chills
to read what the 100 Boston volunteers were willing to risk in the
largest study, one published in the Journal
of the American Medical Association.
Rosenau, MJ. Experiments to determine mode of spread of influenza. JAMA. 1919;73:311-313.
In the above study, Rosenau and his six colleagues took 100 volunteers, "all
of the most susceptible age," none of whom had ever had influenza. That
is, "from the most careful histories that we could elicit, they gave
no account of a febrile attack of any kind," during the previous year
and thus no evidence they would have had immunity to the 1918 virus. The authors
took great care to select their influenza donors from patients in a "distinct
focus or outbreak of influenza, sometimes an epidemic in a school with 100
cases, from which we would select typical cases, in order to prevent mistakes
in diagnosis of influenza." Rosenau went on to say, "A few of the
donors were in the first day of the disease. Others were in the second or third
day of the disease."
Now, read this to see if you would volunteer for the experiments, knowing the
lethality of the 1918 virus.
Then we proceeded to transfer the virus obtained
from cases of the disease; that is, we collected the material and mucous
secretions of the mouth and nose
and bronchi from cases of the disease and transferred this to our volunteers.
We always obtained the material in the following way: The patients with fever,
in bed, have a large, shallow, tray-like arrangement before him or her, and
we washed out one nostril with some sterile salt solution, using perhaps
5 c.c., which is allowed to run into this tray; and that nostril is
into the tray. That is repeated with the other nostril. The patient then
gargles the solution. Next, we obtain some bronchial mucous through
coughing, and then
we swab the mucous surface of each nares and also the mucous membranes of
Then they mixed all this "stuff" together
and squirted it into the noses of the volunteers! "None of them
took sick in any way." Undaunted,
Rosenau reported they conducted another experiment on ten of these brave
The volunteer was led up to the bedside of
the patient; he was introduced. He sat down alongside the bed of
shook hands, and by
instructions, he got as close as he conveniently could, and
they talked for several minutes.
At the end of five minutes, the patient breathed out as hard as he
could, while the volunteer, muzzle to muzzle, received this expired
and at the same
time was breathing in as the patient breathed out. This they repeated
five times, and they did it fairly faithfully in almost all instances.
they had done this five times, the patient coughed directly
into the face of the
volunteer, face to face, five different times. I may say that the
volunteers were perfectly splendid about carrying out the technic
[sic] of these
experiments. They did it with a high idealism. They were inspired
with the thought that
they might help others. They went through the program in a splendid
spirit. After our volunteer had had this sort of contact with the
and chatting and shaking hands with him for five minutes, and receiving
his breath five times, and then his cough directly in his face,
he moved to the
next patient whom we had selected, and repeated this, and so on,
until this volunteer had had that sort of contact with ten different
cases of influenza,
in different stages of the disease, mostly fresh cases, none of them
more than three days old. We will remember that each one of the
sort of intimate contact with each one of the ten different influenza
patients. They were watched carefully for seven days – and
none of them took sick in any way.
Rosenau concluded, "We entered the
outbreak with a notion that we knew the cause of the disease, and were
quite sure we knew how it was transmitted
from person-to-person. Perhaps, if we have learned anything, it is that
we are not quite sure what we know about the disease."
Can you imagine volunteering for this study, the year after 50,000,000
people died in the world from influenza? Courageous volunteers who
about the evidence vitamin D protects one from influenza. I wish modern
virologists would read these 1919 studies, which are the only ones
that ever attempted
to show human influenza is transmitted from the sick to the well. If
knows of any controlled human study, in any language, of any date,
that proves influenza is propagated by an endless series of transmissions
from the sick
to the well, I invite its citation for my continuing education.
One last note: Marc Sorenson has written
a fine book about vitamin D for the general public: Solar
Power for Optimal Health. Marc's
book is available through Amazon.com.
Reprinted with permission from The
Vitamin D Newsletter, February
The Vitamin D Newsletter is a periodic newsletter from the Vitamin
D Council, a non-profit trying to end the epidemic of vitamin D deficiency.
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