10 Points About Vitamin D From A Prime Proponent

http://www.youtube.com/watch?v=xhYmdg58AT8

From: The Journal of D-I-Y Medical Research (which I just made up).
Number of subjects: 1.
Intervention: 2,000 units of Vitamin D per day over one month, after I heard a primary care doctor attest that since he'd started taking more Vitamin D, his aches and pains of middle age had largely disappeared.
Outcome: Subject (yours truly) no longer has to walk stiffly down the stairs in the mornings like a toddler, planting both feet onto each stair before moving on to the next one. Foot and ankle pain mostly gone.
Conclusions: None. You can't conclude anything from a study with an "n" of 1. But the results were intriguing enough to make me attend a lecture today by Dr. Michael Holick, director of the Vitamin D, Skin and Bone Research Laboratory at Boston University. It was titled, "The Solution For Good Health: Rx Vitamin D."

For context, Dr. Holick is clearly a controversial figure. He tends to be hated by some dermatologists because he advocates (moderate, carefully calibrated) sun exposure. He discloses an array of financial ties with various companies — as well as NIH support — and has written two books on Vitamin D, the latest called "The Vitamin D Solution."

But he is not a fringe figure. He remains a professor of medicine, physiology and biophysics at B.U., and he led the Endocrine Society team that issued new practice guidelines on Vitamin D this summer. (They recommended more than a 2010 Institute of Medicine report, which had tripled the recommended levels.)

[module align="right" width="half" type="pull-quote"]Here in Boston, our bodies make virtually no Vitamin D from November to February no matter how long we stay outside.[/module]

I must confess, I had Linus Pauling on my mind when I went to see Dr. Holick speak. For all Pauling's Nobel-winning chemistry brilliance, time appears to have proven him wrong on his great enthusiasm for Vitamin C.

But lately, time seems to be on Dr. Holick's side. Evidence of a broad array of health benefits — and lack of harm — from appropriate doses of Vitamin D has been accumulating, and more studies are in the works. I quake when I pass along recommendations of a vitamin that can have toxic effects if overdone — and the dangers are very real, as the Wall Street Journal's Health Blog reported here. But here are two recent positive signs:

A recent study found a link between vitamin supplements and slightly higher death rates among older women, but  D looked better than some other vitamins. The New York Times wrote, "Some supplements, like iron, were associated with a substantial increase in the risk of death, while others — vitamin A and vitamin D, for example — had no effect."

And check out this 2009 report in one of my most trusted sources of nutrition information, the Nutrition Action newsletter put out by the Center for Science in the Public Interest. The study involves subjects taking 2,000 units of Vitamin D a day:

The article, which is sadly not available online, goes on:

Manson is a principal investigator for the new VITAL trial (VITamin D and OmegA-3 TriaL), which will test vitamin D and omega-3 fats from fish oil on heart disease, stroke, and cancers, especially of the colon, breast, and prostate. But the trial will also look at the supplements’ effect on other illnesses.

“We’re also interested in studying diabetes, high blood pressure, bone density, vision, memory loss, depression, autoimmune diseases, and other health outcomes,” says Manson.

Why launch a brand new trial to test high doses of vitamin D and omega-3s from fish? Don’t we already know they’re worth taking?

“Some people believe the evidence is already strong enough to recommend much higher intakes,” notes Harvard’s JoAnn Manson. “But we tend to forget the lessons of other nutrients—like vitamin E, vitamin C, B vitamins, folic acid, selenium, and beta-carotene.

“Large-scale trials didn’t confirm their benefits and even found some risks when they were consumed at high levels. So let’s not just jump on the bandwagon until we have clinical trials.”

It sounds like Dr. Manson has taken her own tentative step onto that bandwagon; The Boston Globe's Kay Lazar reported here last year:

“I do think vitamin D is one of the most promising nutrients for prevention of cardiac disease and cancer, and I believe in it strongly,’’ Manson said. “But the evidence is far from conclusive.’’
How much D does Manson take?
“I try to take whatever I am testing to see if there [are] side effects and to see if it’s well tolerated,’’ said Manson. Her new study is testing a level of 2,000 IU daily.

I've touched my toe to the Vitamin D bandwagon, too, though I wouldn't dare recommend it to others until studies like JoAnn Manson's come out. Still, Dr. Holick's talk was fascinating, and I wanted to share a brief brain-dump.

He told audience members who had trouble keeping up with his breakneck speed that a similar lecture could be watched on his Website, drholick.com, and I found it here. (Nutrition Action also ran a long Q&A with him in 2003.)

Nine points from my notes:
•"My argument is that our hunter gatherer forefathers were making thousands of units of vitamin D a day that played an important role in their overall health. As a result, throughout evolution humans required several thousand IU of vitamin D either from sun exposure or diet to maximize their overall health and well-being."

•The lay press has been pushing patients to ask doctors to have their Vitamin D tested. Doctors have tended to be resistant, but the assay for Vitamin D is now the most-ordered assay by American doctors today.

•Studies find the majority of American mothers and newborns deficient in Vitamin D. Breast milk does not contain enough Vitamin D. One symptom of Vitamin D deficiency in babies is heavy head-sweating at night.

•Here in Boston, our bodies make virtually no Vitamin D from November to February no matter how long we stay outside. Ethnicity makes no difference.

•Obesity causes Vitamin D deficiency. Obese people need double or more the usual amount of Vitamin D. African Americans are at higher risk for vitamin D deficiency but they need the same amount of vitamin D to prevent and treat vitamin D deficiency as a Caucasian.

•The bone disease associated with Vitamin D deficiency is called osteomalacia, and includes bone pain, muscle aches, stiffness in joints in the morning. It is sometimes misdiagnosed as fibromyalgia.

•Dr. Holick wears sunscreen on his face but allows his arms and legs to get limited sun exposure, and he takes 2,000 units a day of  Vitamin D.

•Vitamin D could help explain some of the striking geographical differences in disease; for example, that multiple sclerosis and Type 1 Diabetes are more common in northern climates.

•Dr. Holick ripped through a long series of studies suggesting that Vitamin D may help with everything from cancer to infections to diabetes to simple longevity.

•Post-lecture question: As with so many things, mightn't we hear in a few years that we've all been taking too much Vitamin D?
Dr. Holick's answer: My argument is that our hunter-gatherer forefathers were making thousands of units a day. I think evolutionarily we've always needed to be there.

And my own final question, heart on sleeve as usual: But what about Linus Pauling?
Dr. Holick:  I received the Linus Pauling prize for human nutrition. I think he would agree today that he may have been off by one letter and that he would likely be promoting vitamin D today.

Readers, have you done any DIY research on Vitamin D of your own? Please share your results but whatever you do, don't overdo it. As the WSJ notes, the Institute of Medicine set the upper limit at 4,000 units a day.

For a broader discussion about vitamin supplements in general, please check out this recent "On Point" show.