Get your Vitamin D levels up before you break a bone.

The October 6, 2010 issue of The Journal of Bone and Joint Surgery reports that nearly half of orthopedic surgery patients are deficient in vitamin D, a condition that impairs bone healing, muscle function and surgery recovery.

Professor of Orthopedic Surgery and chief of the Metabolic Bone Disease Service at New York’s Hospital for Special Surgery Joseph Lane, MD and colleagues reviewed the charts of 723 men and women scheduled for orthopedic surgery from January, 2007 to March, 2008. Forty-three percent of the patients had insufficient preoperative vitamin D levels, defined as 20 to 32 nanograms per milliliter, and 40 percent had deficient levels of less than 20 nanograms per milliliter. Younger individuals, men, and those with dark skin were likeliest to be low in vitamin D.

Dr Lane explained that healing of bony tissue takes place two to four weeks following bone surgery, and sufficient vitamin D is needed for this process. “In the perfect world, test levels, fix and then operate,” Dr Lane stated. “If you are really aggressive right before surgery, you can correct deficient levels quickly, but you have to correct it, measure it, and then act on it.”

Sixty percent of trauma service patients had insufficient levels and 52 percent were deficient. A high percentage of vitamin D insufficiency was also observed in Sports Medicine and Arthroplasty (hip and knee replacement) services. “We frequently see stress fractures in the Sports Medicine Service and if you want to heal, you have to fix the calcium and vitamin D,” Dr. Lane noted. “With arthroplasty, there is a certain number of patients that when you put in the prosthesis, it breaks the bone adjacent to the prostheses, which can really debilitate patients.

“This study should serve as a wake-up call to orthopedists that vitamin D deficiency is widespread, not necessarily tied to age, sex or background and screening for it should be part of routine presurgical care for adults,” Dr Lane stated. “Meanwhile, patients who are planning to undergo any orthopedic procedure can request a screening (specifically, a blood test called the 25 hydroxyvitamin D test) or ask to be placed on a medically supervised vitamin D supplement regimen prior to surgery.”

“The take home message is that low vitamin D has an implication in terms of muscle and fracture healing, it occurs in about 50 percent of people coming in for orthopedic surgery, and it is eminently correctable,” he concluded. “We recommend that people undergoing a procedure that involves the bone or the muscle should correct their vitamin D if they want to have an earlier, faster, better, result. What we are saying is ‘wake up guys, smell the coffee; half of your patients have a problem, measure it, and if they are low, then fix it.'”

Women with Aggressive Breast Cancer are More Likely to Have Low Levels of Vitamin D

The article below was distributed to MD via It is rare to see positive vitamin information being shown to MDs.

MIAMI BEACH, Fla. — Women diagnosed with aggressive and late stage breast cancer are more likely to have low levels of vitamin D compared with women with less dangerous forms of the disease, researchers reported here.

Women who were vitamin D deficient — with plasma concentration less than 20 ng/mL — were eight times more likely to be diagnosed with regional or distant spread of cancer when compared with women who had sufficient levels of the vitamin (OR 8.695% CI 1.8 to 41.2), after statistical adjustments, according to Susan Steck, PhD, MPH, of the University of South Carolina in Columbia.
Severe vitamin D deficiency — plasma concentrations less than 10 ng/mL — were found in 17% of African-American women but not in any white participants, Steck reported here at the American Association for Cancer Research Conference on the Science of Cancer Health Disparities.
About 60% of African Americans with breast cancer who participated in the study had some level of vitamin D deficiency, compared with 14.9% of white women (P<0.0001).
Conversely, just 21.7% of African-American women had sufficient levels of vitamin D compared with 42.6% of white women, Steck and colleagues found.
“We think it may be important to for doctors to monitor the vitamin D blood levels of their patients, especially among African-American patients,” said Steck at a poster presentation.
“We know that darker skin pigmentation acts somewhat as a block to producing vitamin D when exposed to sunlight, which is the primary source of vitamin D in most people,” Steck told MedPage Today. She also noted that higher body mass index and physical activity can impact vitamin D levels.
Steck and colleagues recruited 107 women who were diagnosed with breast cancer in the previous five years. Sixty of these women were African American, while the remaining 47 were white. All women donated a blood sample, and vitamin D status was measured with circulating 25-hydroxyvitamin D (25-OH-D) levels. The mean serum concentration of 25-OH-D was 29.8 ng/mL in white women and 19.3 ng/mL in African-American women.
Serum levels were lowest among patients with triple-negative breast cancer — tumors lacking estrogen, progesterone, and HER2 receptors — and diagnosed in 17 African-American women and seven white women, though the disparity did not reach statistical significance, Steck said.
She said that doctors might want to check levels of vitamin D with their patients and discuss implications of the findings. However, she said further research is required to determine if vitamin D supplementation is worthwhile.
“Vitamin D has become the flavor of the month, with studies that indicate it might be useful in heart disease, cancer, and even Alzheimer’s disease. The question that emerges from these studies is, if we do intervene with vitamin D supplementation, will we improve things for patients?” said Olveen Carrasquillo, MD, chief of general medicine at the University of Miami.
“At one time we had similar thoughts about vitamin E, but when we did the clinical trials, it showed vitamin E had little influence on improving health,” he told MedPage Today. “We don’t know if vitamin D itself is the factor or if levels of vitamin D are markers of some other factor that is related to breast cancer.”
The study’s main statistical findings reflected adjustments for age, race, body mass index, season and months since diagnosis.
One note about the comment about Vitamin E. There is a tremendous amount of very positive research regarding Vitamin E, but vitamins and minerals are not drugs and many pharmaceutically trained researchers look at a single vitamin in isolation to see its impact on a disease. Well when you eat a meal you’re getting many different vitamins and minerals. These work together in the body and vitamin E for example is re-charged by Vitamin C. So you’d never find straight vitamin C in nature, so why would you take straight vitamin E and exclude all others. This is why it is critical to take a high quality multi-vitamin which has all the essential vitamins and minerals together and in the proper proportions.

Vitamins D & E show cognitive benefits

The research keeps pouring in on the benefits of Vitamin D

Eating food rich in vitamin E may reduce the risk of developing dementia, while insufficient levels of vitamin D may increase the risk of cognitive decline, say two new studies.

People who consumed the highest average intakes of vitamin E from the diet were 25 percent less likely to develop dementia than people with the lowest average intakes, according to new data published in the Archives of Neurology.
The benefits are reportedly related to the antioxidant activity of vitamin E, postulate scientists from the Erasmus Medical Center in Rotterdam, the Netherland, which counters the oxidative stress induced by a build up of beta-amyloid protein.
The build-up of plaque from beta-amyloid deposits is associated with an increase in brain cell damage and death from oxidative stress. This is related to a loss of cognitive function and an increased risk of Alzheimer’s, the most common form of dementia and currently affects over 13 million people worldwide.
The direct and indirect cost of Alzheimer care is over $100 bn (€ 81 bn) in the US, while direct costs in the UK are estimated at £15 bn (€ 22 bn).
The study follows hot on the heels of findings from a Swedish study, published in the Journal of Alzheimer’s Disease, which found that a combination of different vitamin E forms could help prevent cognitive deterioration in advanced age.
There are eight forms of vitamin E: Four tocopherols (alpha, beta, gamma, delta) and four tocotrienols (alpha, beta, gamma, delta). Alpha-tocopherol (alpha-Toc) is the main source found in supplements and in the European diet, while gamma-tocopherol (gamma-Toc) is the most common form in the American diet.
Tocotrienols are only minor components in plants, although several sources with relatively high levels include palm oil, cereal grains and rice bran.
Study details
For the new study, the Rotterdam-based scientists analysed data on the intakes of antioxidants – vitamins C and E, beta-carotene and flavonoids – in 5,395 people aged 55 and older. Questionnaires and meal-based checklists were used to establish intakes of these micronutrients.
The participants were followed for about 10 years, during which 465 people developed dementia, of which 365 cases were for Alzheimer’s disease.
After crunching the numbers, the researchers calculated that people with an average intake of 18.5 milligrams of vitamin E per day were 25 percent less likely to develop dementia than the people with an average of 9 milligrams per day. On the other hand, no associations were observed for dietary intake levels of vitamin C, beta-carotene and flavonoids.
“The brain is a site of high metabolic activity, which makes it vulnerable to oxidative damage, and slow accumulation of such damage over a lifetime may contribute to the development of dementia,” wrote the authors.
“In particular, when beta-amyloid (a hallmark of pathologic Alzheimer’s disease) accumulates in the brain, an inflammatory response is likely evoked that produces nitric oxide radicals and downstream neurodegenerative effects. Vitamin E is a powerful fat-soluble antioxidant that may help to inhibit the pathogenesis of dementia.”
D and cognitive decline
The current issue of the Archives of Internal Medicine also carries new data from British researchers, who report that seniors with low levels of vitamin D may be at an increased risk of cognitive decline.
Our cognitive performance declines naturally as we age, but new data from David Llewellyn and his colleagues at the University of Exeter in England indicated that insufficient levels of vitamin D may accelerate this decline.
The Exeter-based scientists analysed vitamin D levels from blood samples of 858 adults aged 65 or older. Cognitive tests were undertaken at the start of the study, and again after three and six years.
The data showed that severe vitamin D deficiency, defined as blood levels of 25-hydroxyvitamin D (25(OH)D) of less than 25 nanomoles per liter – were associated with a 60 percent increase in the risk of substantial cognitive decline.
“If future prospective studies and randomized controlled trials confirm that vitamin D deficiency is causally related to cognitive decline, then this would open up important new possibilities for treatment and prevention,” concluded Llewellyn and his co-workers.
In an accompanying editorial, Andrew Grey and Mark Bolland from the University of Auckland said it was now time to test the various hypotheses generated by observational studies of vitamin D in order to establish the potential public health benefit of raising vitamin D levels.
“Very importantly, such trials will also provide an opportunity to systematically assess potential harms of vitamin D supplementation, an issue that has been largely overlooked or dismissed. We should invest in trials that provide the best possible evidence on the benefits and risks of vitamin D before we invest in costly, difficult and potentially unrewarding interventional strategies,” wrote Grey and Bolland.
Sources: Archives of Intern Medicine 
Vol. 170, Issue 13, Pages 1135-1141 
“Vitamin D and Risk of Cognitive Decline in Elderly Persons”
Authors: D.J. Llewellyn, I.A. Lang, K.M. Langa, G. Muniz-Terrera, C.L. Phillips, A. Cherubini, L. Ferrucci, D. Melzer
Archives of Intern Medicine
Volume 170, Issue 13, Pages 1099-1100
“Vitamin D – A Place in the Sun?”
Authors: A. Grey, M. Bolland
Archive of Neurology
Volume 67, Issue 7, Pages 819-825
“Dietary Antioxidants and Long-term Risk of Dementia”
Authors: E.E. Devore, F. Grodstein, F.J.A. van Rooij, A. Hofman, M.J. Stampfer, J.C.M. Witteman, M.M.B. Breteler

Vitamin D for the weekend warrior

Here is a news segment that aired In Salt Lake City yesterday about a study underway there to study Vitamin D and its effect on muscle recovery in weekend warriors. There is the short print article then a more complete video  in the top right corner.
Research is quickly accumulating which is showing just how important this little vitamin is. Up until a few years ago there were only half a dozen studies a year on Vitamin D, over the last couple of years that has grown to be hundreds of studies a year.

Vitamin D and the Reduced Risk of Many Diseases

Vitamin D and the Reduced Risk of Many Diseases
Vitamin D deficiency is associated with osteoporosis, bone fracture, muscle weakness, cancers (particularly breast and colon), autoimmune diseases, obesity, diabetes, schizophrenia, depression, asthma, lung dysfunction, influenza, kidney disease, and high blood pressure, and cardiovascular disease. During pregnancy and infancy vitamin D insufficiency is also associated with preeclampsia (pregnancy-induced hypertension), low birth weight, neonatal hypocalcemia (low blood calcium), poor postnatal growth, bone fragility, and increased incidence of autoimmune diseases and childhood asthma.
There is no debate in the medical community that there is a vitamin D deficiency epidemic that is causing a myriad of problems, and that people need to be supplementing with much higher doses than the traditionally-recommended dose of 400 IU per day. It’s clear that optimal supplementation should be at least 2000 IU/day, if not 4000 IU/day or higher.

Vitamin D Helps Prevent Osteoporosis
For years, the recommended dose of vitamin D (400 IU/day) was to help strengthen bones and reduce falls and hip fractures. However, there has been an explosion of research (both retrospective and prospective controlled studies), particularly over the last 5 years advancing our understanding that the worldwide vitamin D deficiency epidemic has an effect on much more than bone development and maintenance.
Vitamin D May Help Prevent Insulin Resistance
Adult-Onset Diabetes begins with insulin resistance. It is known that vitamin D deficiency is a common cause of insulin resistance. Although not all studies have been consistent, the studies that have shown a reduction in insulin resistance revealed the association at blood serum vitamin D concentrations ( 25-hydroxvitamin D, or 25-OH-D) in the range of 35 – 42 ng/ml. 1, 2, 3
Vitamin D is Associated with Decreased Risk of Breast and Colon Cancer

Breast Cancer
Blood serum levels of vitamin D (25-OH-D) above 40 ng/ml are associated with a decreased risk of breast and colon cancer. Vitamin D appears to enter breast cancer cells and trigger apoptosis (programmed cell death), much like many antioxidants.
Pooled data from observational studies showed that women whose serum 25-OH-D levels were at least 52 ng/ml had a 50% associated decreased incidence of breast cancer. Certainly, prospective controlled studies are needed to provide further information, but given the safety of vitamin D and encouraging studies thus far there appears to be no reason for anyone to wait on supplementing with optimal doses now. 4, 5, 6, 7
Vitamin D and Reduced Risk of Heart Disease

Heart Disease
Although further studies are needed to determine the full extent of the protective nature of vitamin D against heart disease, it is apparent that vitamin D deficiency increases the risk of both ischemic and non-ischemic heart disease. Vitamin D may influence how heart muscle functions, helps control blood pressure, influences parathyroid hormone levels, and plays a role in reducing inflammation and calcification of blood vessels, thus reducing plaque formation.
When 25-hydroxy-vitamin D levels are below 15 ng/ml the risk for heart disease is particularly elevated. With 25-OH vitamin D levels above 30 ng/ml cardiac benefits may be substantial, and possibly even greater at the optimal serum range of 50 – 80 ng/ml. 8
Vitamin D and Reduced Risk of Influenza

Influenza Infection
Vitamin D reduces the incidence of respiratory infections. 9, 10 Children with the lowest levels of vitamin D are 11 times more likely to develop respiratory infections. 11 When 60,000 IU of vitamin D was given each week for six weeks to children susceptible to respiratory infections the children were completely free of all such infections over the following six months. 12
The influenza virus (the “flu”) causes damage and kills people by causing massive inflammation through uncontrolled over-production of pro-inflammatory cytokines. Vitamin D down-regulates the expression of pro-inflammatory cytokines (such as tumor necrosis factor-alpha). 13 This is the same destructive pro-inflammatory cytokine process that occurs as we age …leading to aging and chronic disease of all organs, vessels, joints, and neurons. 14 , 15
Much could be said about reducing the incidence and severity of influenza, let alone chronic disease, simply by down-regulating the excessive pro-inflammatory cytokine production with optimal supplementation of vitamin D, …in particular with other vitamins, minerals, and antioxidants. If this weren’t enough, vitamin D up-regulates the expression of anti-microbial peptides, (bits of proteins) in immune cells. Anti-microbial peptides damage influenza viruses, bacteria, and fungi (by damaging their outer lipid membranes), allowing the immune system to eliminate them from the body. 16
Vitamin D and Reduced Risk of Complications of Pregnancy

Pregnancy Complications
Vitamin D is essential and a key modulator of calcium metabolism in children and adults, to avoid rickets and osteomalcia, respectively. As the fetus grows during the third trimester calcium demands rapidly increase, and vitamin D requirements become crucial for proper skeletal growth and optimal maternal and fetal outcomes. As with the majority of the population, and despite prenatal vitamin supplementation, vitamin D deficiency is an epidemic among pregnant and lactating women. (As a result vitamin D deficiency is common, if not an epidemic, among breastfed infants as well.)
Adverse health outcomes such as preeclampsia, low birth weight, neonatal hypocalcemia, poor postnatal growth, bone fragility, and increased incidence of autoimmune diseases have been linked to low vitamin D levels during pregnancy and infancy. 17, 18
Minimum adequate blood levels of vitamin D (25-OH-D) during pregnancy should be greater or equal to 32 ng/ml (and possibly closer to 50 ng/ml). In order to achieve and maintain 25-hydroxvitamin D serum levels at 32 – 50 ng/ml, pregnant and lactating women need to supplement with at least 2000 to 4000 IU/day of vitamin D3 per day, which is both safe and effective.
Childhood Asthma Linked to Vitamin D Deficiency.

Childhood Asthma
Vitamin D deficiency may partially explain the asthma epidemic. Recently, low serum vitamin D levels have been associated with higher risks for asthma exacerbations. Vitamin D plays a role in fetal lung growth and development. Epidemiologic studies have also suggested that higher prenatal vitamin D intakes have a protective role against wheezing illnesses in young children. Vitamin D may protect against wheezing illnesses through its multiple immune effects. In addition, vitamin D may play a therapeutic role in steroid resistant asthmatics. 19
Supplementing with vitamin D may help prevent asthma and the exacerbation of this disease, as well as help treat steroid resistance.
Measuring Your Vitamin D Status

25-OH Vitamin D Test
The only true way to know your vitamin D status, and therefore your proper daily dose, is with a blood test, in which the metabolically-active form of vitamin D, 25-hydroxvitamin D (25-OH-D, or calcidiol) is measured. Relatively recently (over the past 5 to 7 years) when vitamin D’s role in the prevention of degenerative diseases beyond prevention of osteoporosis was recognized, the medical experts recommended a minimum target blood level of 30 ng/ml of 25-hydroxyvitamin D. (I emphasize that “minimum target level” means just that, “minimum!” It does not mean “optimal.”) Therefore, the reference lab ranges was raised to 32 – 100 ng/ml. Most experts in the field of researching and treating vitamin D deficiencies have recommended that “optimal” serum 25-OH-D levels begin at 42 ng/ml, with the ideal target range being achieved between 50 – 80 ng/ml.
What Dose of Vitamin D is Optimal?
The vitamin D dose required to attain a serum level range of 50 – 80 ng/ml will vary from person to person, mostly based upon body mass (weight) and sun exposure. Although this will vary considerably, a 150 lb person who supplements with 2000 IU of vitamin D per day may attain blood level range of 25-OH-D between 30 and 45 ng/ml, depending upon sun exposure. To attain the optimal levels between 50 and 80 ng/ml that same person may need to supplement with 4000 IU per day or more.
On the other hand, a person who weighs 225 lbs. may require 10,000 IU/day to maintain 25-hydroxy vitamin D blood serum levels between 50 and 80 ng/ml. In all instances, the only way to accurately know the “true daily dosage” for a particular person would be to first estimate a starting vitamin D dose, get a serum 25-OH vitamin D test; adjust the dose accordingly, and get re-tested several weeks later.
Are High Doses of Vitamin D Safe?
What dose of vitamin D, or more accurately, what serum blood level, is required to prevent chronic disease and maintain optimal health AND not have toxic side effects? In other words, is long-term “high dose” vitamin D3 supplementation safe?
There is concern that high doses of vitamin D may elevate serum calcium levels and cause kidney stones in those at risk. To partially answer that question we can look at one study in which participants were administered extremely high doses of vitamin D. In a 12 week study, 69 vitamin D deficient patients received either a single oral, or a single intramuscular injection of 300,000 IU of vitamin D. During the 12 week study no cases of hypercalcemia (elevation of blood calcium) were observed. 20
There are no credible reports of vitamin D toxicity with chronic daily vitamin D3 supplementation up to 10,000 IU/day. Many vitamin D expert clinicians are routinely recommending doses well above 10,000 IU/day. Hypercalcemia (an elevated serum calcium level) is only observed with synthetic vitamin D analogues, such as calcitriol. 21
Are there Contraindications for High-Dose Vitamin D?
Primary hyperparathyroidism is the main contraindication. Also, high dose vitamin D supplementation may cause elevation of serum calcium levels in patients with sarcoidosis, tuberculosis, or lymphoma. Therefore, in such cases, patients dosing with levels above 2000 IU per day should do so only with caution AND under the care and direction of a physician.
One Last Word: Maintain Proper Ratios and Balance of Vitamins

Vitamin Ratio and Balance
Vitamin D is one powerful, important, and safe nutrient in which we all should be taking. However, it should be taken with a full balance, and proper spectrum and ratio of vitamins, minerals, essential fatty acids and other antioxidants for optimal health. One example of proper ratios and understanding of supplementation is the fact that supplementing with vitamin A can neutralize the beneficial effects of vitamin D. 22
Most people are aware that high levels of vitamin A can cause birth defects and harm the liver. However, most are not aware that vitamin A and vitamin D compete for each other’s function in the body. Supplementing with excess amounts of vitamin A can suppress the important cancer-fighting effects of vitamin D. 23, 24
Most multivitamin preparations contain vitamin A. Vitamin A (or pre-formed vitamin A) is different from pro-vitamin A, or beta-carotene. Beta-carotene does not interfere with vitamin D. Nor is beta-carotene associated with birth defects or liver problems.
Therefore, in choosing a quality, broad spectrum supplement brand, it is important to choose one that provides beta-carotene (a.k.a. “pro-vitamin A”), not vitamin A. This is just one of many criteria in choosing a quality supplement brand. As it relates to this article, choose a supplement that provides a daily dose of vitamin D3 of at least 2000 IU/day, and consider taking 4000 IU/day and having your blood tested to achieve the target range of 50 – 80 ng/ml.
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Vitamin D Deficiency Linked to Diabetes, Metabolic Syndrome in Studies

SATURDAY, June 19 (HealthDay News) — A pair of new studies has uncovered evidence that low levels of vitamin D could lead to poor blood sugar control among diabetics and increase the risk of developing metabolic syndrome among seniors.
Both findings are slated to be presented Saturday at the Endocrine Society’s annual meeting in San Diego.
In one study, researchers at the Johns Hopkins University School of Medicine in Baltimore reviewed the medical charts of 124 type 2 diabetes patients who sought specialty care at an endocrine outpatient facility between 2003 and 2008.

More than 90 percent of the patients, who ranged in age from 36 to 89, had either vitamin D deficiency or insufficiency, the authors found, despite the fact that they all had had routine primary care visits before their specialty visit.

Just about 6 percent of the patients were taking a vitamin D supplement at the time of their visit, the research team noted, and those who had lower vitamin D levels were also more likely to have higher average blood sugar levels.

“This finding supports an active role of vitamin D in the development of type 2 diabetes,” study co-author Dr. Esther Krug, an assistant professor of medicine, said in a news release from the Endocrine Society.

“Since primary care providers diagnose and treat most patients with type 2 diabetes, screening and vitamin D supplementation as part of routine primary care may improve health outcomes of this highly prevalent condition,” Krug added.

A second study involving nearly 1,300 white Dutch men and women over the age of 65 found almost half were vitamin D-deficient, while 37 percent had metabolic syndrome.

Metabolic syndrome is a grouping of health risk factors, including high blood pressure, abdominal obesity, abnormal cholesterol levels and high blood sugar.

“Because the metabolic syndrome increases the risk of diabetes and cardiovascular disease, an adequate vitamin D level in the body might be important in the prevention of these diseases,” study co-author Dr. Marelise Eekhoff, of VU University Medical Center in Amsterdam, said in the same news release.

Regardless of gender, those with insufficient amounts of vitamin D in their blood were more likely to have the syndrome than those with sufficient amounts of vitamin D, Eekhoff and her colleagues found.

“It is important,” added Eekhoff, “to investigate the exact role of vitamin D in diabetes to find new and maybe easy ways to prevent it and cardiovascular disease.”

What is Vitamin D?

Vitamin D3 (Cholecalciferol)

Technical Background

  • Vitamin D is a fat-soluble nutrient that plays a central role in bone growth and health.1 It can be acquired either through the diet or through exposure to sunlight, when ultraviolet light reacts with a form of cholesterol and converts it to vitamin D. Cholecalciferol is the form of vitamin D normally found in humans and the form typically found in nutritional supplements.
  • A unique property of vitamin D is that it functions very much like a hormone. Its target tissues in the human body include the kidneys, intestines, and bones, where it acts to regulate calcium and phosphorus homeostasis.1
  • In the intestines, vitamin D plays an important role in the absorption of calcium. In bone tissue, vitamin D plays a role in regulating calcium deposition (bone mineralization) and mobilization.1
  • Given the above functions, vitamin D is essential for normal bone development, particularly in children. Without it, bones do not calcify properly, leading to the condition known as “rickets”. Vitamin D also plays an important role in tooth development. It is necessary for proper tooth eruption, growth, and ultimate strength.
  • Research is currently being done to examine the role of vitamin D and its analogues in inhibiting prostate cancer2 and breast cancer.3 Recently, a research team reviewed 63 studies on the relationship between vitamin D and certain types of cancer. In addition to prostate and breast cancer, the majority of studies found a relationship between vitamin D status and lower risk of colon and ovarian cancers as well.4 In another recent study, women taking a calcium and vitamin D supplement had a 60 percent lower incidence of all cancers than women not taking the supplement.5
  • Vitamin D intake is especially important for women. In addition to its possible role in breast cancer and osteoporosis prevention,6 recent studies have found that vitamin D and calcium supplementation in pre-menopausal women may also decrease in the incidence of premenstrual syndrome (PMS).7
  • A recent study found that over half of the women in North America receiving treatment for osteoporosis had an inadequate intake of vitamin D.8 New research indicates that vitamin D deficiencies are widespread among pregnant women and infants despite prenatal vitamin usage.9
  • Vitamin D is also being researched for its role as an immune system regulator and modulator,10,11 for its role in reducing insulin resistance and type-2 diabetes,12,13 and for its role in healthy heart and lung function.14,15

Sources and Recommended Intake

  • The Recommended Dietary Allowance (RDA) for vitamin D is 5 micrograms (200 IU) per day for children, and 5-15 micrograms (200-600 IU) per day for adults.16 These amounts can be obtained with 15-30 minutes of exposure to sunlight on the hands, arms, and face. The use of sunscreens interferes with vitamin D synthesis. Dark skin (i.e. having a high melanin content) requires longer exposure than lighter skin to achieve the same degree of vitamin D synthesis17. Furthermore, the capacity of skin to synthesize vitamin D decreases with age.18
  • The only significant dietary source of vitamin D is fortified milk. Other sources include fish and fish liver oils.19
  • Although the upper limit established by the Food and Nutrition Board is 2,000 IU (or 50 mcg), many prominent researchers view this a being too restrictive. Human clinical trial data published after the establishment of the UL support a significantly higher UL. Absence of toxicity in trials conducted in healthy adults support the level of 10,000 IU as a more reasonable UL.20
  • Importantly, the benefits of vitamin D supplementation are achieved only if adequate calcium and phosphorus are provided in the diet.

1 – Norman, AW. 1996. Vitamin D. Pp. 120-129. In EE Ziegler and LJ Filer (eds). Present Knowledge in Nutrition. ILSI Press, Washington, DC.
2 – Woo TC, Choo R, Jamieson M, Chander S, Vieth R. Pilot study: potential role of vitamin D (Cholecalciferol) in patients with PSA relapse after definitive therapy. Nutr Cancer. 2005;51(1):32-6.
3 – Mehta RR, Bratescu L, Graves JM, Green A, Mehta RG. Differentiation of human breast carcinoma cells by a novel vitamin D analog: 1alpha-hydroxyvitamin D5. Int J Oncol. 2000 Jan;16(1):65-73.
4 – Garland CF et al. The Role of Vitamin D in Cancer Prevention. American Journal of Public Health, Vol 96, No. 2 252-261 February (2006).
5 – Lappe JM et al. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. The American Journal of Clinical Nutrition 2007 June; 85(6):1586-91.
6 – Papadimitropoulos E, Wells G, Shea B, Gillespie W, Weaver B, Zytaruk N, Cranney A, Adachi J, Tugwell P, Josse R, Greenwood C, Guyatt G. Meta-analyses of therapies for postmenopausal osteoporosis. VIII: Meta-analysis of the efficacy of vitamin D treatment in preventing osteoporosis in postmenopausal women. Endocr Rev. 2002 Aug;23(4):560-9.
7 – Bertone-Johnson ER, Hankinson SE, Bendich A, Johnson SR, Willett WC, Manson JE. Calcium and vitamin D intake and risk of incident premenstrual syndrome. Arch Intern Med. 2005 Jun 13;165(11):1246-52.
8 – Holick MF, Siris ES, Binkley N, Beard MK, Khan A, Katzer JT, Petruschke RA, Chen E, de Papp AE. Prevalence of vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab. 2005 Jun;90(6):3215-24.
9 – Bodnar LM et al. High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates. J. Nutr. 137:447-452, February 2007
10 – Cantorna MT, Zhu Y, Froicu M, Wittke A. Vitamin D status, 1,25-dihydroxyvitamin D3, and the immune system. Am J Clin Nutr. 2004 Dec;80(6 Suppl):1717S-20S.
11 – Mathieu C, van Etten E, Decallonne B, Guilietti A, Gysemans C, Bouillon R, Overbergh L. Vitamin D and 1,25-dihydroxyvitamin D3 as modulators in the immune system. J Steroid Biochem Mol Biol. 2004 May;89-90(1-5):449-52.
12 – Chiu KC et al. Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr 2004 May;79(5):820-5.
13 – Pittas AG et al. Vitamin D and calcium intake in relation to type 2 diabetes in women. Diabetes Care 29:650-656, 2006.
14 – Major GC el al. Supplementation with calcium + vitamin D enhances the beneficial effect of weight loss on plasma lipid and lipoprotein concentrations. Am J Clin Nutr, Vol. 85, No. 1, 54-59, January 2007.
15 – Black PN and Scragg R. Relationship between serum 25-hydroxyvitamin d and pulmonary function in the third national health and nutrition examination survey. Chest 2005 Dec;128(6):3792-8.
16 – Institute of Medicine. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington D.C.: National Academy Press. 1997
17 – Clemens, TL and others. 1982. Increased skin pigment reduces capacity of skin to synthesize vitamin D3. Lancet 1: 74-76.
18 – Webb, AR and others. 1988. Influence of season and latitude on the cutaneous synthyesis of vitmain D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J. Clin. Endocrinol. Metab. 67: 373-378.
19 – Cohen, RD and NS Braunstein. 1995. Vitasearch. Great Bay Nutrition Resources, New Market, NH. 49 pp.
20 – Hathcock JN, Shao A, Vieth R, and Heaney R. Risk assessment for vitamin D. Am J Clin Nutr 2007 Jan;85(1):6-18

Canada Shines Light on Sunshine Vitamin – Vitamin D for colds and flu

Instead of getting a swine flu or other flu vaccine, Dr. Northrup suggests following what our Northern neighbors are doing to truly prevent the swine flu—taking vitamin D. Last year, the Public Health Agency of Canada (PHAC) began a multi-year study to see whether adequate vitamin D levels helped to prevent the flu. Although originally designed to study the seasonal flu, PHAC has now modified the study to examine the correlation between vitamin levels and those who contract the H1N1 swine flu virus. Dr. Northrup commends Canada for their forward thinking.

Since 2006, Dr. Northrup has been teaching women (and men) everywhere about the protective, health-enhancing qualities of the sunshine vitamin. Optimal levels of vitamin D (40–80 ng/ml) enhance the creation and functioning of healthy cells throughout the body.1 In addition to protecting the bones and boosting the immune system, studies show that vitamin D helps prevent certain cancers, including breast, ovarian, prostate, and colorectal.23 45 Exciting new research shows that in the U.S. alone, thousands of new cases of breast cancer could be prevented every year if more women had optimal levels of vitamin D.6

Vitamin D also benefits the immune system, as studies by prominent vitamin D researchers have shown. This year, Adit Ginde, M.D. published a study conducted with about 19,000 adults and teens which found that those with low levels of vitamin D were 40 percent more likely to come down with a cold, the flu, or other respiratory infections.7 In the past, John J. Cannell and Michael Hollick, the granddaddies of vitamin D research, have published numerous studies showing similar correlations. (For more information, visit the Vitamin D Council web site.) It appears that vitamin D has antimicrobial properties that kick in when the body is exposed to these kinds of germs.8

As we all know, when some people get the flu, it’s mild and they recover quickly while others develop secondary infections, like pneumonia, or asthma and other serious conditions. PHAC plans to study if there’s a correlation between vitamin D levels and whether a person develops a severe case of the flu. Dr. Northrup says, “This makes sense. A study done on 208 post-menopausal African Americans showed that women who received 800 IUs per day of vitamin D were three times less likely to get a cold or flu, regardless of the season, when compared to women who took no vitamin D. And when the women studied were given 2,000 IUs per day, virtually none came down with either kind of virus.”9

PHAC also plans to examine whether genetics play a role.

Although it’s likely to take at least three flu seasons before enough information can be gathered and interpreted, Dr. Northrup is willing to guess that the results will shine a light on the sunshine vitamin’s effectiveness. “With all this talk about healthcare reform, I’m encouraged to see a country take a stand for prevention. I can picture a much healthier world, not because of a vaccine or a pill, but because people everywhere have adequate levels of vitamin D.”

Dr. Northrup continues, “If you do nothing else for yourself or your family this year, do this one thing: maintain an optimal level of vitamin D. In my opinion, this is 52 ng/mls or higher, but no higher than 100 ng/ml. (The current consensus among vitamin D researchers is 40–80 ng/ml or as high as 100 ng/ml.) A simple blood test will tell you where your stand. Then you’ll either get about 2,000 IUs per day to maintain a healthy level, or take a little more until your levels have been restored.

“This is true health care!” Dr. Northrup enthuses.

For more on boosting your immune system and protecting against the flu, read “Build Your Immunity!” in the Women’s Wisdom Circle. For more on vitamin D’s many benefits, read “How Natural Light Recharges Your Health” also in the Wisdom Circle.


  1. Staud, R., 2005. Vitamin D: more than just affecting calcium and bone. Curr Rheumatol Rep, Oct;7(5):356-64.
  2. Staud, R., 2005. Vitamin D: more than just affecting calcium and bone. Curr Rheumatol Rep, Oct;7(5):356-64.
  3. Cannell, J.J., Hollis, B.W. 2008. Use of vitamin D in clinical practice, Altern Med Rev, Mar;13(1):6-20.
  4. Cannell, J.J., et al. 2008. On the epidemiology of influenza, Virol J, Feb 25;5:29.
  5. Holick, M.F. 2004. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis, Am J Clin Nutr, 79:362-71.
  6. Garland, C.F., et al. 2009 Vitamin D for cancer prevention: global perspective, Ann Epidemiol. Jul;19(7):468-83.
  7. Ginde, A.A, Mansbach, J.M., Camargo, C.A. Jr. 2009. Arch Intern Med. Feb 23;169(4):384-90. Comment in Arch Intern Med. 2009 Aug 10;169(15):1443; author reply 1443-4.
  8. Doss, M., et al. 2009. Interactions of alpha-, beta-, and theta-defensins with influenza A virus and surfactant protein D, Journal of Immunology, Jun 15; 182(12): 7878-87
  9. Aloia, J., Li-Ng, M. 2007. Epidemic influenza and vitamin D, Epidemiol Infect 135(7):1095-1096.

Fifteen facts you probably never knew about vitamin D and sunlight exposure.

Fifteen facts you probably never knew about vitamin D and sunlight exposure.

Vitamin D prevents osteoporosis, depression, prostate cancer, breast cancer, and even effects diabetes and obesity. Vitamin D is perhaps the single most underrated nutrient in the world of nutrition. That’s probably because it’s free: your body makes it when sunlight touches your skin. Drug companies can’t sell you sunlight, so there’s no promotion of its health benefits. Truth is, most people don’t know the real story on vitamin D and health. So here’s an overview taken from an interview between Mike Adams and Dr. Michael Holick.

1. Vitamin D is produced by your skin in response to exposure to ultraviolet radiation from natural sunlight.
2. The healing rays of natural sunlight (that generate vitamin D in your skin) cannot penetrate glass. So you don’t generate vitamin D when sitting in your car or home.
3. It is nearly impossible to get adequate amounts of vitamin D from your diet. Sunlight exposure is the only reliable way to generate vitamin D in your own body.
4. A person would have to drink ten tall glasses of vitamin D fortified milk each day just to get minimum levels of vitamin D into their diet.
5. The further you live from the equator, the longer exposure you need to the sun in order to generate vitamin D. Canada, the UK and most U.S. states are far from the equator.
6. People with dark skin pigmentation may need 20 – 30 times as much exposure to sunlight as fair-skinned people to generate the same amount of vitamin D. That’s why prostate cancer is epidemic among black men — it’s a simple, but widespread, sunlight deficiency.
7. Sufficient levels of vitamin D are crucial for calcium absorption in your intestines. Without sufficient vitamin D, your body cannot absorb calcium, rendering calcium supplements useless.
8. Chronic vitamin D deficiency cannot be reversed overnight: it takes months of vitamin D supplementation and sunlight exposure to rebuild the body’s bones and nervous system.
9. Even weak sunscreens (SPF=8) block your body’s ability to generate vitamin D by 95%. This is how sunscreen products actually cause disease — by creating a critical vitamin deficiency in the body.
10. It is impossible to generate too much vitamin D in your body from sunlight exposure: your body will self-regulate and only generate what it needs.
11. If it hurts to press firmly on your sternum, you may be suffering from chronic vitamin D deficiency right now.
12. Vitamin D is “activated” in your body by your kidneys and liver before it can be used.
13. Having kidney disease or liver damage can greatly impair your body’s ability to activate circulating vitamin D.
14. The sunscreen industry doesn’t want you to know that your body actually needs sunlight exposure because that realization would mean lower sales of sunscreen products.
15. Even though vitamin D is one of the most powerful healing chemicals in your body, your body makes it absolutely free. No prescription required.

On the issue of sunlight exposure, by the way, it turns out that super antioxidants greatly boost your body’s ability to handle sunlight without burning. Astaxanthin is one of the most powerful “internal sunscreens” and can allow you to stay under the sun twice as long without burning. Other powerful antioxidants with this ability include the superfruits like Acai, Pomegranates (POM Wonderful juice), blueberries, etc.

Diseases and conditions cause by vitamin D deficiency:

* Osteoporosis is commonly caused by a lack of vitamin D, which greatly impairs calcium absorption.
* Sufficient vitamin D prevents prostate cancer, breast cancer, ovarian cancer, depression, colon cancer and schizophrenia.
* “Rickets” is the name of a bone-wasting disease caused by vitamin D deficiency.
* Vitamin D deficiency may exacerbate type 2 diabetes and impair insulin production in the pancreas.
* Obesity impairs vitamin D utilization in the body, meaning obese people need twice as much vitamin D.
* Vitamin D is used around the world to treat Psoriasis.
* Vitamin D deficiency causes schizophrenia.
* Seasonal Affective Disorder is caused by a melatonin imbalance initiated by lack of exposure to sunlight.
* Chronic vitamin D deficiency is often misdiagnosed as fibromyalgia because its symptoms are so similar: muscle weakness, aches and pains.
* Your risk of developing serious diseases like diabetes and cancer is reduced 50% – 80% through simple, sensible exposure to natural sunlight 2-3 times each week.
* Infants who receive vitamin D supplementation (2000 units daily) have an 80% reduced risk of developing type 1 diabetes over the next twenty years.

Shocking Vitamin D deficiency statistics:

* 32% of doctors and med school students are vitamin D deficient.
* 40% of the U.S. population is vitamin D deficient.
* 42% of African American women of childbearing age are deficient in vitamin D.
* 48% of young girls (9-11 years old) are vitamin D deficient.
* Up to 60% of all hospital patients are vitamin D deficient.
* 76% of pregnant mothers are severely vitamin D deficient, causing widespread vitamin D deficiencies in their unborn children, which predisposes them to type 1 diabetes, arthritis, multiple sclerosis and schizophrenia later in life. 81% of the children born to these mothers were deficient.
* Up to 80% of nursing home patients are vitamin D deficient.

What you can do:
Sensible exposure to natural sunlight is the simplest, easiest and yet one of the most important strategies for improving your health. I urge you to read the book, “The UV Advantage” by Dr. Michael Holick to get the full story on natural sunlight. You can find this book at most local bookstores or through,, etc. Note: This is not a paid endorsement or an affiliate link. I recommend it because of its great importance in preventing chronic disease and enhancing health without drugs or surgery. This may be the single most important book on health you ever read. If more people understood this information, we could drastically reduce the rates of chronic disease in this country and around the world. Sunlight exposure is truly one of the most powerful healing therapies in the world, far surpassing the best efforts of today’s so-called “advanced medicine.” There is no drug, no surgical procedure, and no high-tech procedure that comes even close to the astonishing healing power of natural sunlight.

And you can get it free of charge. That’s why nobody’s promoting it, of course.
(Compiled by Mike Adams, based on an interview with Dr. Michael Holick, author, The UV Advantage)

Unfortunately most people can’t get enough Vitamin D from the sun, so supplements are available.

Canada examines vitamin D for swine flu protection

The Public Health Agency of Canada (PHAC) has confirmed that it will be investigating the role of vitamin D in protection against swine flu.

The agency started a study last year on the role of vitamin D in severe seasonal influenza, which it said it will now adapt to the H1N1 swine flu virus.

“Researchers in PHAC are working with colleagues at McMaster University and with partners at other universities and hospitals to determine whether there is a correlation between severe disease and low vitamin D levels and/or a person’s genetic make up. This line of research in seasonal influenza will be adapted to H1N1,”

PHAC said it is testing serum samples to examine this possibility in collaboration with colleagues at the University of Toronto.

Preventing ‘severe outcomes’

Part of the researchers’ goal is to understand if vitamin D levels are in any way responsible for the fact that most people with seasonal influenza develop a mild illness but a small minority go on to develop severe symptoms.

According to PHAC, results from its study will indicate the extent and nature of the role of vitamin D in sever seasonal influenza. The agency said it would most likely take at least three influenza seasons to be able to recruit a sufficient sample size of individuals with severe disease and controls before the results can be “meaningfully” analyzed.

“If we find that there is a correlation between severe disease and vitamin D levels we shall, with our partners in the future, conduct randomized controlled studies to determine the whether vitamin D can be used as a means to mitigate severe seasonal influenza,” it said.

“PHAC intends to adapt this strategy to H1N1 in order to prevent severe outcomes of infection.”

Experimental models

The agency stressed that the role of vitamin D in H1N1 is not well established. However, it added that early work in the 1940s, in experimental animal models, indicated that mice that receive diets low in vitamin D are more susceptible to experimental swine flu infection than those that receive adequate vitamin D (Young, 1946).

In addition, PHAC said that epidemiological evidence suggests a role for vitamin D in seasonal influenza in general.

“Influenza infection is correlated geographically and seasonally with levels of solar ultraviolet radiation (Cannell, 2006). Given that vitamin D is synthesisized in our skin on exposure to sunlight, low serum levels of 25(OH) vitamin D in winter months appear to correlate with the occurrence of seasonal influenza in the winter. However a direct causal relationship between low vitamin D levels and the risk of influenza remains to be proven.”

“How vitamin D might protect against influenza infection is not fully understood. However new research suggests that vitamin D induces the production of antimicrobial substances in the body that possess neutralizing activity against a variety of infectious agents including influenza virus (Doss, 2009).”

Be aware of vitamin D insufficiency

In an update to its position statement on Vitamin D, the American Academy of Dermatology has cautioned that some individuals may be at risk of “insufficiency”,

and may therefore need to consume higher doses of the vitamin.

The group continues to recommend that vitamin D is obtained from nutritional sources and dietary supplements rather than the sun, but now says that those who consistently avoid the sun may not be getting enough of the vitamin.
“The vitamin D position statement supports the Academy’s long-held conviction on safe ways to get this important vitamin – through a healthy diet which incorporates foods naturally rich in vitamin D, vitamin D-fortified foods and beverages, and vitamin D supplements,” said David Pariser, president of the American Academy of Dermatology.
“The updated recommendation for individuals who practice daily sun protection acknowledges that while protecting the skin from the damaging rays of the sun is important, so is maintaining adequate vitamin D levels. Concern about vitamin D should not lead people to forego sun protection, but rather prompt a conversation with their physician about how to ensure adequate and safe vitamin D intake while guarding against skin cancer.”
The major function of vitamin D in the human body is the maintenance of blood serum concentrations of calcium and phosphorus by enhancing the absorption of these minerals in the small intestine.
However, although the vitamin is essential in humans, experts have noted that about one billion people are estimated to be vitamin D deficient, even more so since very few foods are fortified with the vitamin.
Vitamin D deficiency may precipitate or exacerbate osteopenia, osteoporosis, muscle weakness, fractures, common cancers, autoimmune diseases, infectious diseases and cardiovascular diseases. There is also some evidence that the vitamin may reduce the incidence of several types of cancer and type 1 diabetes.
Cancer protection
However, the new position statement from the American Academy of Dermatology emphasizes that the cancer reduction benefits of vitamin D do not yet have sufficient scientific backing.
“Contrary to some reported information about vitamin D and the prevention of certain cancers and diseases – other than for bone health – we simply need more clinical data to determine what role, if any, vitamin D plays in these conditions,” said Dr Pariser.
Others at risk of insufficiency
The Academy also stressed that people with known risk factors for vitamin D insufficiency may need to consume higher doses of the vitamin.
People in this category include those with dark skin, the elderly, photosensitive individuals, people with limited sun exposure, obese individuals or those with fat malabsorption.
The position statement said the standard reference intake levels for vitamin D are those set by the US Institute of Medicine (IOM).
Currently, IOM recommends that children and adults up to age 50 should consume 200 International Units (IU) of vitamin D per day – equivalent to 5μg. Adults aged between 51 and 70 should have an intake of 400 IU (10 μg), and adults aged 71 and over should consume 600 IU (15 μg).
Because high levels of vitamin D can be toxic, IOM has set a tolerable upper intake level (UL) of 1,000 IU per day for infants, and 2,000 IU for children and adults.
“The currently recommended adequate intake levels established by the Institute of Medicine may be revised upward due to evolving research on the increasing clinical benefit of vitamin D,” said the Academy, adding that the US Department of Agriculture (USDA) Dietary Guidelines notes a daily total dose of 1,000 IU of vitamin D for supplementation of those at-risk for vitamin D insufficiency.

Higher Vitamin D levels are Associated with Better Outcomes in Prostate Cancer Patients

There was a recent study published in the February, 2009 edition of the British Journal of Cancer that investigated vitamin D levels in prostate cancer patients. They found that prostate cancer patients that had a medium-high level of vitamin D (20 to 32 ng/ml) had a 66% increase in survival rate and those who had a high level of vitamin D (greater than 32 ng/ml) had an 80% increase in survival compared to those with a low level of vitamin D (less than 20 ng/ml).

This is a pretty amazing study when you realize that I recommend that you should have at least a vitamin D level over 50 ng/ml and ideally over 60 ng/ml. This is just another good reason to be sure that your vitamin D levels are optimal. Obviously, if you have recently been diagnosed with prostate cancer, you should get your vitamin D levels checked right away.

From Dr. Ray Strands – Health Nuggets