Fibromyalgia & Classical
A double-blind, randomized, parallel-group, placebo-controlled pilot study
(Rheumatology. 2004; 43: 577-582) "demonstrated
that individualized homeopathy is significantly better than placebo in lessening
pain and improving the quality of life and global health of persons with
fibromyalgia." Sixty-two people with physician-confirmed fibromyalgia
took part in the six-month study. Each was assessed by two experienced classical
homeopaths at a clinic in Phoenix, Arizona. The homeopaths were instructed
to agree on one homeopathic remedy (with a confidence rating of at least
seven out of ten) for the patient to take daily. The research team hoped
having two homeopaths agree on a treatment would increase the likelihood
that the correct remedy was chosen for each patient. An inaccurately chosen
remedy will have no effect (i.e., work like a placebo), reducing the number
of participants who receive active treatment and skewing the results toward
a negative finding. Patients in this study received either the prescribed
remedy (liquid LM potencies) or an indistinguishable placebo, according to
a randomization code. Hahnemann Laboratories in California dispensed the
remedies and placebos directly to the patients. A split sample research bottle
was sent directly to the research pharmacist. During the study, only the
methodologist in Tucson and Hahnemann's pharmacist had access to the
Patients visited the homeopaths at baseline, two months, four months, and six
months. Homeopaths were permitted to change remedies and potencies whenever
clinically indicated throughout the trial. Patients also traveled to the University
of Arizona (Tucson) for laboratory assessment at baseline, three months, and
six months. There, all patients completed questionnaires and had a physical
exam by a conventional provider who rated trigger point pain. Patients were
also given electroencephalographic (EEG) and electrocardiographic tests that
recorded their responses to double-blind, olfactory-administered test doses
of their treatment solution and the solvent. Interestingly, EEG responses differentiated
between the homeopathic remedy and the placebo (solvent) and identified exceptional
clinical responders from other patients.
Bell IR, Lewis DA, II, Brooks AJ, et al. Improved clinical status in fibromyalgia
patients treated with individualized homeopathic remedies versus placebo. Rheumatology.
2004;43:577-582. Available at: http://rheumatology.oxfordjournals.org/cgi/reprint/keh111v1.
Accessed July 5, 2006.
Williams M. Individualized homeopathy helps fibromyalgia sufferers. Available
at: http://bastyrcenter.org/content/view/420/&page=1. Accessed July 5,
Plastic Bottles & Bisphenol
A few years ago, I bought a polycarbonate plastic bottle (i.e., Nalgene)
for drinking water. I was told that polycarbonate plastic does not
into the liquid it holds. Then, I noticed a response to a letter in Co-op
America Updates (March/April 2006) that sent me searching online for information
to support or refute my assumption that polycarbonate is the best choice.
I learned that polycarbonate plastic – used in drinking bottles, baby
bottles, microwave ovenware, as a coating in metal cans, and as a plastic
coating for children's teeth to prevent cavities – releases bisphenol-A
(BPA). BPA has several negative health effects, especially for children and
Industry uses over 6.4 billion pounds of this compound each year, according
to Frederick S. vom Saal and Claude Hughes. In a commentary that calls for
a new risk assessment for BPA (Environmental Health
Perspectives. August 2005),
vom Saal and Hughes state that 94 of 115 in vivo studies, published as of December
2004, reported significant effects from low-dose exposure to BPA. In 31 of
these studies, effects occurred below the "safe" or reference dose
of 50 micrograms/kg/day. Chemical manufacturers contest these findings; industry-funded
studies report no significant effects from low doses of BPA. In contrast, over
90% of government-funded studies have detected significant negative effects,
according to vom Saal and Hughes.
Many of the effects are due to BPA's hormonal properties. Bisphenol A
is among the chemicals that Dr. Theo Colburn, co-author of Our
identifies as "weakly" estrogenic compounds. In vitro experiments
have demonstrated that BPA disrupts cell function at 10-12 M or 0.23 ppt. Like
other "weak" estrogenic compounds, bisphenol A is "as powerful
as estrogen at increasing calcium influx into cells and stimulating prolactin
secretion." A January 2006 study in Environmental
Health Perspectives says that BPA's estrogenic effect disrupts pancreatic ß-cell function
and induces hyperinsulinemia and insulin resistance in mice. BPA also has shown
negative effects on prostate development in mice, including "susceptibility
to adult-onset precancerous lesion and hormonal carcinogenesis." In addition,
low-dose bisphenol A causes aneuploidy (chromosome abnormalities) in mice.
Aneuploidy in humans produces birth defects and miscarriages. A small study
by Japanese researchers found that women with a history of repeated spontaneous
miscarriages had higher BPA levels.
BPA has also been linked to changes in brain structure and altered
behavior. Female mice exposed to low levels of BPA (one-fifth the
amount considered safe)
spent less time nursing and more time out of the nest and away from the offspring.
The brains of male rats that have been exposed to "safe" BPA levels
show an increase in the size of the locus ceruleus. Part of a major norepinephrine
pathway, the locus ceruleus, believed to be a fear/anxiety center, is normally
larger in females than in males. This pattern reverses when rats are exposed
High heat, alkalinity, and repeated use are known to increase the amount
of BPA that leaches from polycarbonate containers. But a recent study from
University of Missouri found that polycarbonate releases BPA at room temperature
and neutral pH. The researchers compared BPA levels in purified water that
sat in animal cages, made from different materials, for one week. They found: "Significant
estrogenic activity, identifiable as BPA by [gas chromatography/mass spectrometry]
(up to 310 micrograms/L), was released from used polycarbonate animal cages.
Detectable levels of BPA were released from new polycarbonate cages (up to
0.3 micrograms/L) as well as new polysulfone cages (1.5 micrograms/L), whereas
no BPA was detected in water incubated in glass and used polypropylene cages." Polysulfone
has a higher temperature and chemical tolerance than polycarbonate and is
supposed to leach BPA less readily, according to manufacturers. The University
researchers warn that the use of BPA-leaching equipment can compromise the
accuracy of experiments investigating estrogenic chemicals.
Pregnant women and children may be particularly vulnerable to the widespread
use of polycarbonate plastics. Vom Saal and Hughes state that "the median
BPA level in human blood and tissues, including in human fetal blood, is higher
than the level that causes adverse effects in mice." The information
on www.ourstolenfuture.org has encouraged me to return to using glass, steel,
or polypropylene bottles.
Alonso-Magdalena P, Morimoto S, Ripoli C, et al. The estrogenic effect of
bisphenol a disrupts pancreatic b-cell function in vivo and induces insulin
Environmental Health Perspectives. 2006;114: 106-112.
Howdeshell KL, Peterman PP, Judy BM, et al. Bisphenol A is released from
used polycarbonate animal cages into water room temperature. Environmental
Perspectives. 2003;111:1180-1187. Available at: www.ehponline.org/members/2003/5993/5993.pdf.
Accessed June 22, 2006.
"Is Polycarbonate Really Dangerous?" Co-op
America Updates. March/April
Our Stolen Future. Background on BPA. Available at: www.ourstolenfuture.org/NewScience/oncompounds/bisphenola/bpauses.htm.
Accessed June 22, 2006
Vom Saal FS, Hughes C. An extensive new literature concerning low-dose effects
of bisphenol A shows the need for a new risk assessment (Abstract). Environmental
Health Perspectives. 2005;113:926-933. Available at: www.ehponline.org/doc/2005/7713/abstract.html.
Accessed June 22, 2006
Reviews & Evidence-Based
Systematic reviews, derived from individual studies, are part of
the move towards evidence-based medicine. Using the principles of
research synthesis, researchers
find and assess studies that relate to specific questions, such as "Does
black cohosh relieve hot flashes?" The studies are then summarized
and synthesized so that the researchers can provide an overall interpretation
that responds to the question. This interpretation may change as new studies
arise, so systematic reviews should be updated periodically. To reduce subjectivity
and bias, at least two researchers should independently select and access
pertinent studies for a systematic review, using an explicit, reproducible
method. Systematic reviews help people make treatment decisions based on
the volumes of studies being conducted; but like the studies themselves,
systematic reviews have some shortcomings.
Individual studies, used in systematic reviews, vary in quality and study
design. Although randomized, double-blind, placebo-controlled studies usually
top the "hierarchy
of evidence" list, this study design is not useful for determining rare
side effects. In addition, these studies are usually short-term, making it
impossible to evaluate long-term effects. M.G. Myriam Hunink, professor of
clinical epidemiology and radiology in Rotterdam, The Netherlands, wrote that
a case control or observational study is better for identifying rare side effects
of a treatment and that cohort studies provide the best evidence for causes
of illnesses and prognoses.
Drug studies showing a positive effect are more likely to be published that
those that show a neutral or negative effect, and industry-funded or affiliated
studies are more likely to show a greater response than those performed by
independent researchers. For this reason, systematic reviewers try to find
unpublished studies, including adverse reports and post-marketing studies.
Otherwise, they risk creating a review that overestimates a treatment's
effectiveness and underestimates its negative effects. Hilda Bastian of Cologne,
Germany, describes "the first of many experiences of being led down the
garden path by a systematic review because of absent or weak information on
adverse effects" in the British Medical Journal (October 30, 2004).
Systematic review methodology is also susceptible to conscious or unconscious
biases. The criteria that researchers chose for evaluating relevant studies
influences the results of a systematic review. "There are many different
scales for assessing the strength and quality of a study that may be included
in a review," journalist Roy Moynihan explains in his Milbank Memorial
Fund report Evaluating Health Services: A Reporter
Covers the Science of Research Synthesis. "Like the whole science of research synthesis, these scales
are evolving." As an example, Moynihan refers to a 1999 JAMA study conducted
by Peter Juni and colleagues (JAMA. 282:1054-60). The team used the 17 trials
from a published meta-analysis (a type of systematic review) that compared
low-molecular-weight heparin to standard heparin as prevention for deep vein
thrombosis, but the team evaluated the trials' quality with a variety
of scales. Some of the resulting meta-analyses indicated that low-molecular-weight
heparin was more effective than standard heparin. Other analyses showed the
exact opposite. As a unit, the 25 meta-analyses, conducted by Juni and colleagues,
showed no overall difference in the effectiveness of the two treatments. Moynihan
says that "part of the controversy surrounding the systematic review
of mammography screening for breast cancer, published in The
Lancet in 2001,
arose because different researchers have different views on the quality and
strength of the original studies that were reviewed."
Despite the limitations of systematic reviews, health care insurers, hospitals,
and government agencies are depending upon them to clarify the haze generated
by a flood of research studies. Moynihan lists several organizations that produce
good quality systematic reviews: Canadian Coordinating Office for Health Technology
Assessment, Cochrane Collaboration, National Health Service Center for Reviews
and Dissemination, National Institute for Clinical Excellence, Scottish Intercollegiate
Guidelines Network, and United States Preventive Services Task Force. It is
important to remember that these reviews are works-in-progress.
Bastian H. Learning from evidence-based mistakes. BMJ. 2004; 329:1053. Available
at: http://bmj.bmjjournals.com/cgi/content/full/329/7473/1053. Accessed July
Hunink MGM. Does evidence based medicine do more good than harm? BMJ. 2004;329:1051.
Available at: http://bmj.bmjjournals.com/cgi/content/full/329/7473/1051. Accessed
July 5, 2006.
Juni P, Witschi A, Bloch R, et al. The hazards of scoring the quality of clinical
trials for meta-analysis (Abstract). JAMA. 1999;282:1054-60. Available at:
http://jama.amaassn.org/cgi/content/abstract/282/11/1054. Accessed July 31,
Moynihan R. Evaluating Health Services: A Reporter
Covers the Science of Research Synthesis. New York: Milbank Memorial Fund, 2004. ISBN 1-887748-56-3.
Genes & Chemical
Genetic differences may explain why some people develop multiple chemical sensitivity
(MCS) and others do not, according to a 2004 International
Journal of Epidemiology study. Epidemiologist Gail McKeown-Eyssen of University of Toronto (Canada)
led a study that investigated variations in five genes – CYP2D6, NAT1,
NAT2, PON1, and PON2—among 365 Caucasian women (203 with MCS and 162
controls). These genes govern the body's production of drug-metabolizing
The researchers found that women with MCS were more likely to have more active
forms of CYP2D6 and NAT2. Women with higher CYP2D6 activity were more than
three times as likely to be chemically sensitive than those with inactive CYP2D6.
Enzymes governed by CYP2D6 break down chemicals that include neurotransmitters,
central nervous system medications (e.g., various antidepressants, stimulants,
and codeine), and procarcinogens (substances that break down into reactive,
carcinogenic compounds). Women with a rapid metabolizing form of NAT2 were
four times more likely to be chemically sensitive than those with those with
slow-metabolizing NAT2. Women with active forms of both genes were 18 times
more likely than controls to have chemical sensitivity, a finding that McKeown-Eyssen
views with caution. The original study design did not include analyses for
such an interaction, and the number of participants with this gene combination
was very small.
The researchers hypothesize that people with these active gene forms may be
metabolizing chemicals faster than the body can eliminate the resulting toxic
byproducts, creating the varied symptoms of MCS.
McKeown-Eyssen G, Baines C, Cole DEC, et al. Case-control study of genotypes
in multiple chemical sensitivity: CYP2D6, NAT1, NAT2, PON1, PON2 and MTHFR.
International Journal of Epidemiology. 2004; 33:971-978. Available at: http://ije.oxfordjournals.org/cgi/content/short/33/5/971.
Accessed on June 22, 2006.
Spivey A. Genes and sensitivity. Environmental Health
Intolerance & Addiction
Chemical intolerance may be the "flipside" of chemical addiction,
according to Claudia S. Miller, professor of environmental and occupational
medicine at the University of Texas Health Science Center (San Antonio). "Addicted
individuals seek repeated hits of a substance," she explained [in an
article for Chemical & Engineering News], "while the chemically intolerant
shun many of the same substances. But the reason for these seemingly opposite
behaviors may well be the same — to avoid unpleasant withdrawal symptoms." Miller
says that addiction and chemical intolerance may also have a similar neurotransmitter
pathway and pathophysiology. Miller organized a 2005 joint meeting of the National
Institute of Environmental Health Sciences (NIEHS) and the National Institute
on Alcohol Abuse and Alcoholism (NIAAA) so that researchers from the two specialties
could share information and research methods.
One of the speakers at the conference was Barbara A. Sorg, professor of neuroscience
at Washington State University (Pullman). Sorg has used rats to investigate
the involvement of the limbic system in chemical sensitivity. Researchers know
that repeated doses of cocaine sensitize the mesolimbic dopamine pathway in
the rat's brain, leading to addiction. Using rats that had never been
exposed to cocaine, Sorg repeatedly exposed them to low levels of formaldehyde
vapor. Later, when she administered cocaine to these rats, they responded as
if they had been previously sensitized to cocaine, suggesting that the mesolimbic
pathway may have been sensitized by the formaldehyde exposure.
Another speaker, David H. Overstreet, has developed a strain of rats that could
be used as an animal model for chemical intolerance. Overstreet is a professor
of psychiatry at the University of North Carolina (Chapel Hill). Flinders Sensitive
Line (FSL) rats, like people who are chemically sensitive, react negatively
to organophosphate pesticides, such as diisopropyl fluorophosphate (DFP). FSL
rats and chemically intolerant people also react to nicotine, ethanol, and
many drugs, including serotonin agonists and dopamine antagonists. When exposed
to egg protein, FSL rats exhibit increased gut permeability and airway reactivity.
Food intolerance and asthma are among the symptoms reported by chemically sensitive
people. FSL rats also show signs of depression, including inactivity, disinterest
in eating, and intermittent sleep. Depression is another common complaint of
people with chemical intolerance.
Chemical intolerance disables or compromises the life quality of three-to-six
percent of the US population. Organizers of the conference hope that collaboration
between the two specialties will lead to preventive and treatment strategies
for chemical intolerance.
Hileman B. Chemical intolerance. Chemical & Engineering News. October 10,
2005; 83;(41):24-29. Available at: http://pubs.acs.org/email/cen/html101005155844.html.
Accessed June 22, 2006.
Treatment Ratings for Multiple Chemical Sensitivity
Researchers at James Madison University (Harrisonburg, Virginia)
gathered information from 917 people with self-reported multiple
chemical sensitivity (MCS) concerning
their experience with various treatments. Respondents to this survey reported
using over 101 treatments, including environmental medicine techniques, holistic
therapies, individual nutritional supplements, detoxification techniques,
body therapies, Eastern-origin techniques, prescription items, and
others. The researchers
hoped the survey would give patients, many of whom rely on disability or
worker's compensation for income, a way to evaluate possible treatments.
that evaluate MCS treatment are very limited.
The survey, published in Environmental Health
Perspectives (Sept. 2003),
gives the number of people who tried each treatment, the respondents' ratings
for the treatment, and a help:harm ratio (the number of people who reported
the treatment helpful compared to the number reporting it harmful). "Treatments
with the highest help:harm ratios have more positive and fewer negative effects,
according to respondents' perceived efficacy ratings," the authors
explain. Creating a chemical-free living space, chemical avoidance, and
prayer had the highest help:harm ratios. Of the 820 people who had created
living space, 94.8% said it was helpful, 4.5% said it had no effect, and
0.6% found it harmful. This intervention, however, was quite expensive;
spent a mean of $57,000 to create a safe home. Of the 875 who used chemical
avoidance, 94.5% found it helpful, 4.7% reported no effect, and 0.8% experienced
a negative effect. Using air filters to prevent exposure was also rated
helpful by 82.1% of the 786 who tried them. Of the 609 people who sought
prayer, 64.2% said it helped, 34.4% reported no effect, and 1.4% reported
harm. Rotation diet, personal oxygen to cope with exposures, acupressure,
and moving to a safe location all had help:harm ratios over 10, meaning
ten times as many people rated it helpful as rated it harmful. Pharmaceuticals
(including antidepressants) and provocation-neutralization testing for
with preservative drew the highest negative response.
The researchers write: "Many people noted in the qualitative comments
that it was only the combination of treatments that helped them improve.
Many reported that it was necessary to do environmental controls, a correctly
program of nutritional supplements, and a number of other interventions
that addressed their own unique constellation of symptoms."
Gibson PR, Elms ANM, Ruding LA. Perceived treatment efficacy for conventional
and alternative therapies reported by persons with multiple chemical sensitivity.
Environmental Health Perspectives. 2003;111:1498-1504. Available at: www.ehponline.org/members/2003/5936/5936.pdf.
Accessed July 5, 2006.
Magnetic Resonance Imaging Evidence of Fibromyalgia
A study, published in Arthritis & Rheumatism (May 2002), used functional
magnetic resonance imaging (fMRI) to provide evidence that 16 people diagnosed
with fibromyalgia (FM) showed greater sensitivity to pain than 16 healthy,
matched controls. The researchers used a 1-cm3 hard rubber probe attached to
a hydraulic piston to apply controlled, repeatable pressure of five-second
duration to the left thumbnail beds of each participant. As the pressure gradually
increased from 0.45 kg/cm2 to 9 kg/cm2 or to tolerance, participants described
their experience of pain and unpleasantness using a numerical analog descriptor
scale. fMRI patterns were similar in patients and controls when the pain/unpleasantness
rating was the same, but controls required more pressure to elicit the same
pain rating given by FM patients. Earlier studies have shown that people with
FM and those without it tend to notice sensory stimulation (electrical, thermal,
mechanical) at the same levels, but those with FM report painful or unpleasant
sensations at lower stimulation levels
This fMRI experiment also found that mild pressure activated only two areas
of the brain in control subjects compared to 12 areas of activation in the
patients. Eight of those 12 areas became active in control subjects when stimulation
pressure reached higher levels. Hypervigilance and anticipation of pain are
known to activate sensory areas of the brain, but the study's authors
rule out both factors because they found a pattern of decreased activity in
the anterior cingulate cortex. This area of the brain becomes more active during
anticipation and attention, not less. Decreased activity in this area occurs
during hypnotic analgesia (insensitivity to pain). The study's authors
view their findings as support for the hypothesis that "FM is characterized
by cortical or subcortical augmentation of pain processing."
Richard H. Gracely, PhD, one of the study's authors told WebMD, "What
[this study] shows is that the brain response is consistent with what the patients
report verbally….Being believed is an extremely important issue for these
people. Now these physical findings are emerging, it is gratifying for these
patients [sic]….The general public doesn't realize that pain can
be very severe – and sometimes untreatable – in a person who does
not seem to be injured."
DeNoon D. Brain scan proves what sufferers have always known. WebMD
Medical News. Available at: www.webmd.com/content/article/48/39261.htm. Accessed on
July 5, 2006.
Gracely RH, Petzke F, Wolf JM, Clauw DJ. Functional magnetic resonance imaging
evidence of augmented pain processing in fibromyalgia. Arthritis & Rheumatism.
Marshall Protocol for Sarcoidosis
Trevor G. Marshall, PhD, affiliated with Autoimmunity Research Foundation (Thousand
Oaks, California), has developed a therapy to treat sarcoidosis. Marshall
characterizes sarcoidosis as a Th1 inflammatory disease caused by pleomorphic
intracellular bacteria. Marshall says that the bacteria infect phagocytes,
triggering a cytokine release that leads to a "runaway immune reaction." The
bacteria are also present in the blood of healthy people, but this disease
develops in people with susceptible alleles on the HLA-DRB1 gene. Marshall
and colleagues believe that overproduction of 1,25-dihydroxyvitamin D is
another predisposing factor. Vitamin D controls the TH1 immune response,
according to Marshall, and is nearly always elevated in people with sarcoidosis.
Sarcoid inflammation can affect several organs including the lungs, spleen,
liver, skin, heart, and brain.
Moscovic first discovered acid-fast, Cell Wall Deficient (CWD) bacteria in
biopsy specimens from sarcoidosis patients in 1978. Since then, Borrelia, Mycobacterium,
Rickettsia, and Propionibacterium have been found in sarcoidosis patients.
Pleomorphic bacteria transform into cell wall-deficient microbes as a defense
against hostile environments within the body and as a defense against antibiotics
that attack the bacterial cell wall.
The Marshall Protocol (MP) uses long-term antibiotic therapy to weaken these
bacteria so that the immune system can destroy them. The protocol begins with
no more than 25 mg of minocycline every 48 hours. Patients experience Jarisch-Herxheimer
Shock (JHS) as the bacteria die off and release toxins. If the microbes are
killed too quickly, patients can die. Consequently, doctors must monitor patients
carefully and prescribe a dosage that produces JHS reactions that the patient
finds tolerable. Marshall's team has observed that "patients who
do not experience significant JHS are not killing the bacteria at a rate fast
enough to induce remission of their sarcoid inflammation." Skin reactions,
breathing difficulties, and bradycardia are among the common reactions to the
The protocol calls for a gradual increase in minocycline over the first three
months of treatment. When a patient tolerates 100 mg of minocycline every 48
hours, one quarter of a 250 mg azithromycin tablet (˜62 mg) once a week
is added to their regimen. Over several months, the azithromycin dosage gradually
increases to 250 mg/week. With both antibiotics at "full dosage," a
little sulfamethoxazole/trimethoprim can be taken with the minocycline to boost
its effectiveness against resistant bacteria.
More information about the Marshall Protocol is available at http://AutoimmunityResearch.org.
In addition, www.MarshallProtocol.com has a forum for medical professionals
only, and www.SarcInfo.com has papers for physicians and patient tutorials.
Autoimmunity Research Foundation. The Marshall Protocol. Available at: http://AutoimmunityResearch.org/phase1.pdf.
Accessed June 22, 2006.
Marshall TG, Fenter BJ, Marshall F. Antibacterial therapy induces remission
in sarcoidosis. Journal of Independent Medical Research. 1957 (October 26,
2005). Available at: www.joimr.org/phorum/read.php?=2&i=107&t=107.
Accessed June 22, 2006.
Marshall TG, Marshall FE. Sarcoidosis succumbs to antibiotics - implications
for autoimmune disease. "Autoimmunity Reviews." 2003;3(4):295-300.
Available at: http://yarcrip.com/sarcoidosissuccumbs-preprint.htm. Accessed
June 22, 2006.
Vitamin D Recommendations
New knowledge about vitamin D's role in preventing several serious conditions
is propelling the Institute of Medicine to re-examine the recommended daily
allowance (RDA). Vitamin D deficiency has been linked to common cancers, autoimmune
diseases, type 1 diabetes, heart disease, and osteoporosis. Because muscle
pain and aching bones are common signs of vitamin D deficiency, it is often
misdiagnosed as fibromyalgia or chronic fatigue syndrome, according to Michael
F. Holick, PhD, of Boston University School of Medicine.
Humans make vitamin D when ultraviolet B (UVB) rays from sunlight reach our
skin. Reduced exposure to sunlight and the use of sunscreen inhibit the amount
of vitamin D that we produce. Oily fish (salmon, sardines, mackerel) and cod
liver oil also provide D, but few people in the US consume these regularly.
Dark skin, aging, and obesity are other causes of low serum levels. To help
offset vitamin D deficiency, milk, packaged cereals, and some yellow spreads
are supplemented with vitamin D2 or vitamin D3. Dr. Laura Armas from Creighton
University (Omaha, Nebraska) and colleagues found that a single 50,000 IU dose
of D3 results in higher blood levels of vitamin D and 25-hydroxyvitamin D (a
biologically active form of D made in the liver) than does the same dose of
D2, and levels remain high for a longer period. D3 supplements, however, are
manufactured in a process that uses lanolin, a concern for vegetarians.
The Adequate Intake (AI), set by the Food and Nutrition Board of the Institute
of Medicine in 1997, is 200 IU/day for infancy through age 50, 400 IU for people
51-70, and 600 IU for those over 70 years. Holick and other vitamin D experts
recommend a minimum of 1000 IU/day, according to an article on RedOrbit
However, people with primary hyperparathyroidism, sarcoidosis, tuberculosis,
and lymphoma need to consult a qualified practitioner before supplementing
with vitamin D because of the risk of hypercalcemia (high blood levels of calcium).
Hypercalcemia is also characterized by muscle pain and weakness and can lead
to calcification of organs if left untreated for a long period. Concerns about
inducing hypercalcemia have kept vitamin D intake recommendations low. Jane
Higdon, PhD, at the Linus Pauling Institute (Portland, Oregon), says: "Research
published since 1997 suggests that the UL [upper intake level] for adults is
likely overly conservative and that vitamin D toxicity is very unlikely in
healthy people at intake levels lower than 10,000 IU/day. Vitamin D toxicity
has not been observed to result from sun exposure."
Higdon J. Vitamin D. Available at: http://lpi.oregonstate.edu/infocenter/vitamins/vitaminD/index.html.
Accessed July 6, 2006.
Vitamin D deficiency: common cause of many ailments. RedOrbit
10, 2005. Available at: www.redorbit.com/modules/news/tools.php?tool=print&id=126369.
Accessed July 5, 2006.