Why should you keep your vitamin D level around 50 ng/ml? September 19, 2011 -- Dr John
Cannell
Why should you
keep your vitamin D level around 50 ng/ml? Four different sources,
using four different rationales, and four different lines of reasoning,
all lead to the same conclusion.
First, what is the vitamin D level of our closest simian relatives, such
as chimpanzees living wild in Africa? Professor Reinhold Vieth reports
the answer is between 40 and 60 ng/ml. This, by itself, does not prove
we need such levels, but it certainly raises that question.
Second, what is the vitamin D level of humans who work in the sun
without clothes, such as lifeguards, and without supplementing? We lived
in the sun for 2 million years, so certainly lifeguards have more
natural vitamin D levels than do people who work indoors. Again, the
answer is between 40-60 ng/ml. Here, we have stronger naturalistic
evidence unless one assumes the vitamin D levels of indoor workers are
natural.
Third, what vitamin D levels do women have to achieve to convert from
having little to having lots of vitamin D in their breast milk?
Professors Bruce Hollis and Carole Wagner recently answered that
question, again 40-60 ng/ml, enough to sustain the infant’s vitamin D
levels. One could claim breast milk is not supposed to have vitamin D in
it, and that primitive man was supposed to expose newborns to sunlight.
But then you would be arguing that primitive man was supposed to expose
their infants to predators, which I find unlikely. Besides, we know
from the second reason that any woman receiving consistent full body sun
exposure would have vitamin D in her breast milk.
Finally, what is the vitamin D level of people who show no evidence of
substrate starvation? That is, at what level do people begin to store
the parent compound (cholecalciferol) in their fat and muscles?
Professor Robert Heaney answered that question: around 40 ng/ml. I
remember seeing several patients in the hospital who had vitamin D
levels of 40-50 ng/ml in February. Both had worked as roofers the summer
before and both had worked with their shirts off. The mechanism for
humans who migrated away from the equator must have been the same, to
store the parent compound in muscle and fat during the summer for use in
the winter. The body stores it well before it turns on the enzymatic
machinery to get rid of excess vitamin D.
So we have the above four questions, questions from four very different
sources. Chimps, outdoor workers, lactating women, and clinical subjects
all lead to the same answer: 40 ng/ml is the lower limit of a natural
level. Taking into account errors in laboratory testing and variations
in human techniques, we must accept what the Endocrine Society recently
recommended, that healthy vitamin D levels are somewhere around 50
ng/ml, levels the Vitamin D Council has advocated for the last 8 years.
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09) 11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15
Woohoo! I just got my Vitamin D test results and it's 64! Last summer it was 66 so with what I'm taking I'm able to keep it in this range. A big improvement from when I was diagnosed and it was only 19.
Donna
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09) 11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15
That's really interesting Donna as it's one of our challenges to find out how much to take to maintain the better high levels...so you were on 5,000 IU this past year?
I take 5k of Vit D, a multivitamin and 2 citracel's a day. I think the Vit D3 amount in all of them add up to 6,500 ius. During the end of radiation I did add another 2k of Vit D3 for a few weeks.
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09) 11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15
Latest case-studies on vitamin D toxicity September 29, 2011 -- Dr John Cannell
In September, 2011, two papers with three case reports of vitamin D toxicity were published. Two cases were manufacturing errors and one was a pharmacist’s mistake. Vitamin D levels associated with clear toxicity ranged from 194 to 1220 ng/ml. To my knowledge, toxicity occurring at 194 ng/ml is the lowest vitamin D level causing clear toxicity known in the medical literature. In the first case, a pharmacist’s dispensing error occurred when the doctor wrote a prescription for 1,000 IU/day of D3. Since it was not a prescription item, the pharmacist thought the doctor meant prescription Drisdol, which is 50,000 IU. So the patient, a 70-year old woman with mild dementia, began taking 50,000 IU/day of D2. She was also taking, for reasons unknown, 3100 mg of calcium per day.
Three months later she developed confusion, slurred speech, unstable gait, and increased fatigue. Probably due to her dementia, she did not complain of the most common symptoms of toxicity: lack of appetite, excessive thirst, nausea, abdominal pain and increased urination. Her vitamin D level was 194 ng/ml, her calcium (CA) was 14.6 (8.5-10.5 is normal); her kidney function was impaired with a creatinine of 5.3 (CR); her activated vitamin D level was normal, her urine CA/CR ratio was elevated, but she had no anemia. All vitamin D and calcium was withheld and her doctors treated her with IV fluids. Four days later her symptoms disappeared and her calcium returned to normal and her creatinine improved to 3.0. Five months later her vitamin D level was 40, her calcium was 9.2, and her creatinine was back at baseline, 1.8.
To my knowledge, this is the first modern case report of toxicity at 50,000 IU/day (and this was D2), although this case also included 3100 mg/day of calcium. Unfortunately, I have heard that a few physicians use 50,000 IU/day routinely. It is too much, way too much. However, this lady completely recovered with no damage to her kidneys.
Secondly, why would anyone take 3100 mg/day of calcium? In this case she was demented. However, many people believe that the government recommendation of 1200 mg/day of calcium for females over the age of 50 means they should literally take 1200 mg/day as a supplement. It does not mean that at all. It means total dietary and supplement intake should be 1200 mg/day and everyone gets some calcium in their diet. Most people need no more than 500 mg/day of calcium as a supplement and many people who eat dairy three times a day need none.
The other two cases were equally interesting, but involved manufacturing errors. It is one of the reasons I recommend you get your vitamin D from one of our sponsors, Stop Aging Now or Bio-Tech-Pharmacal (links on the right). Both companies are experienced and careful in their vitamin D manufacturing process.
In case two, an otherwise healthy man developed fatigue, excessive thirst, frequent urination and confusion. Three weeks later he was admitted to hospital in a coma with a vitamin D level of 1220 ng/ml (24 times that of a healthy level), calcium of 15, activated vitamin D of 106, massive calcium loss in the urine, mild anemia, and elevated urine CA/CR ratio. He had been taking “Formula F,” labeled to contain 1600 IU of vitamin D but it really contained 186,400 IU per capsule. In addition, “Formula F’s” label recommended 10 capsules per day, not one, so the patient had been taking 1,864,000 IU daily for two months! After treatment, calcium returned to normal in three weeks; the vitamin D level and the creatinine returned to normal in a year. That is, he completely recovered.
Case three (in the above paper) was a 40-year old man who presented with excessive thirst, frequent urination, muscle aches, nausea, vomiting, elevated calcium (13.2), elevated creatinine (1.78), vitamin D level of 645 ng/ml, elevated activated vitamin D of 99, mild anemia, and an elevated urine Ca/Cr ratio. He reported taking “Gary Null’s Ultimate Power Meal” for a month, which mistakenly contained 970,000 IU of vitamin D per serving. Calcium returned to normal in several days, kidney function returned to normal in 4 weeks, vitamin D level normalized in 10 months but activated vitamin D took a year to normalize. No permanent injuries occurred, much to the chagrin of the trial lawyers.
The takeaway from these three papers is that if you take more than 10,000 IU/day, you must check your 25(OH)D regularly. I am concerned that people with levels greater than 150 ng/ml may be urinating out more calcium than they should; that is urinating out their bones. A 1988 paper suggested exactly that and I have clinic experience that shows in at least one person, a 24 hour urine calcium was elevated before the urine Ca/Cr ratio was abnormal. To be safe, keep your 25(OH)D vitamin D levels below 100 ng/ml.
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09) 11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15
Canadian women invited to join global Vitamin D study to help prevent breast cancer
TORONTO, October 31, 2011 -- At a time when more and more evidence is pointing to a direct link between increased vitamin D levels and a reduction in breast cancer, a new study announced today by GrassrootsHealth is seeking to find some answers for Canadian women.
The GrassrootsHealth Breast Cancer Prevention Study in Canada will seek to prospectively examine the occurrence of breast cancer among Canadian women 60 and over who achieve and maintain a targeted vitamin D serum level in the bloodstream.
Participants will be monitored and will be able to attain optimal vitamin D levels through their choice of UVB exposure, fortified foods or supplements. In addition to breast cancer prevention, short-term effects of vitamin D on hypertension, falls, colds and flu will also be tracked. The study aims to enroll 1000 women to rapidly demonstrate the health outcomes. “We have been provided seed funding to get the project started immediately and will be actively looking for more sources of funding to continue its support,” said Carole Baggerly, director of GrassrootsHealth.
"We are hoping the study will solidify and quantify the case that vitamin D experts have been building for years: that increased vitamin D levels in women will significantly reduce breast cancer," states Dr. Robert Banner, President Ontario Society of Physicians for Complementary and Integrative Medicine.
“It is essential Canadian women be included in our drive to demonstrate the medical benefits of vitamin D. When you can project that fully 75% of breast cancer cases could be prevented with higher optimal vitamin D serum levels, there is no justification for waiting to take preventive measures,” said GrassrootsHealth founder Carole Baggerly, herself a breast cancer survivor. “Ultimately we want women to know how they can proactively help prevent breast cancer before it is discovered at a screening clinic,” she added.
Canadian women over 60 years old are invited to join women across the world in the five-year Breast Cancer Prevention Study initiated by GrassrootsHealth. To be eligible to enroll, women must be at least 60 and have no current cancer or current cancer treatment.
The study aims to fully demonstrate health outcomes of vitamin D serum levels in the range of 100-150 nmol/L, natural biological levels and will examine the occurrence of breast cancer among a population of women 60 and over who achieve and maintain a targeted vitamin D serum level in the bloodstream.
“The more women who participate in this study, the greater the chance that we will defeat breast cancer within our lifetimes,” Baggerly said.
GrassrootsHealth welcomes Canadian health organizations interested in contributing to the study and seeing the effects vitamin D can have on preventing breast cancer.
About Grassroots Health GrassrootsHealth (GRH), a non-profit public health research organization, works to quickly elevate public health messages from science into practice. GRH joins with vitamin D scientists to aggregate knowledge and best practices and then spread the word to medical practitioners and individuals in order to change public opinion and create healthier life choices and prevent disease. To signup for the breast cancer study or for more information, visit:https://www.grassrootshealth.net/proj-welcome?pr=562331
Prescription vitamin D
(D2) less effective than over-the-counter vitamin D (D3) according to a
meta-analysis.
Meta-analysis
looks at efficacy of D2 vs D3 Prescription vitamin D (D2) less
effective than over-the-counter vitamin D (D3) according to a
meta-analysis.
Written by John
J. Cannell, M.D.
November 16, 2011
Permission to reprint
SAN LUIS OBISPO, CA -- Many people write me and ask, “My doctor
prescribed Drisdol, is that OK?” Drisdol is D2 and the form of vitamin D
that doctors write prescriptions for. The body doesn’t produce vitamin
D2 in response to sun exposure. It is made by irradiating fungus and
plant matter. When you take it, a number of metabolic forms of D2 are
found in the body, and some studies show D3 (produced by the skin) is
more potent, meaning it is more effective at raising blood levels than
D2, while some show they are equal. However, there are few studies
comparing the efficacy of D2 vs. D3. Or in other words, which form has
better health outcomes, better mortality rates?
Recently, a
review and meta-analysis address this question. The meta-analysis study
was led by Professor Dr. Goran Bjelakovic.
He analyzed 50
randomized controlled trials (RCTs) with a total of 94,000 participants
that used some form of vitamin D and reported mortality rates as either
primary or secondary outcomes. Within these RCTs, 32 of the studies used
D3 (74,000 subjects) and 12 of them used D2 (18,000 subjects). He found
there was a 6% relative risk reduction when supplementing with vitamin
D3, as opposed to a 2% relative risk increase when supplementing with
vitamin D2
Amazingly, this
study somehow slipped under the radar and neither the press nor I picked
up this study in July. Luckily, Professor Dr. Harvey Murff of
Vanderbilt University reviewed this study yesterday in the Annals of
Internal Medicine recently, allowing the general public to examine the
study once again.
You would think a
paper that took a look at tens of thousands of subjects and analyzed
the efficacy of prescription vitamin D (D2) and over-the-counter vitamin
D (D3) would warrant a news story or two. To my knowledge, these papers
are the first to paint such a clear picture about the efficacy between
D3 and D2. While there may be explanations for D3’s superiority other
than improved efficacy, for the time being, these papers send doctors a
message: use D3, not D2.
Thanks for continuing to be so diligent in researching for us! The Vitamin D increasingly sounds like it makes good sense for all people, but we women with BC really need to pay attention! Nine months before my diagnosis I had tested low (I know, big surprise) and is just one more of those 'coincidences'...
SAN ANTONIO -- Women who have higher levels of vitamin D when
they're diagnosed with breast cancer appear to have smaller tumors,
researchers said here.
In a retrospective study, lower vitamin D levels were significantly
associated with larger tumor size (P=0.0063), Barbara Brouwers, PhD, of
the University of Leuven in Belgium, reported during a poster session
at the San Antonio Breast Cancer Symposium here.
"Lower vitamin D levels were correlated with much bigger tumors,"
she told MedPage Today. "We also saw that higher vitamin D levels were
associated with better outcomes, but it wasn't significant."
Brouwers explained that many studies have shown that vitamin D
status is important in many chronic illnesses, and some have even shown
low vitamin D levels to be a risk factor for breast cancer, as well as a
predictor of outcomes.
Yet it's difficult to interpret its specific role given the many
confounding factors known to influence serum concentrations, such as
dietary intake, seasonal variation, and weight.
Also, genetic variants regarding vitamin D metabolism
could influence risk, she added.
So to assess the potential associations between vitamin D status
and genetic variability on breast tumor characteristics and outcomes,
Brouwers and colleagues looked at data from a cohort of 1,800 early
breast cancer patients treated at their clinic between 2003 and 2010.
Data on serum 25-hydroxy vitamin D3 levels was collected at
diagnosis for all patients, and they were followed for a mean of four
years.
The researchers found that lower vitamin D levels were
significantly associated with larger tumor size; each 0.4 ng/mL decrease
in levels was linked with a 1-cm increase in tumor size (P=0.0063).
There were no associations, however, between vitamin D levels and
other characteristics such as lymph
node invasion, ER or HER2 status, or tumor grade.
Patients with lower vitamin D levels at diagnosis tended to have a
higher risk of breast-cancer related death, though the finding wasn't
significant, Brouwers said.
In multivariate analyses, however, the relationship became of
borderline significance, as the risk of death from breast cancer fell
27% per 10 ng/mL increase in serum vitamin D levels at diagnosis, they
reported.
For patients who were clearly vitamin D deficient -- having a level
below 30 ng/mL at diagnosis -- there was a significant increase in the
risk of relapse after three years, Brouwers and colleagues found.
On the other hand, patients who weren't deficient had a lower risk
of relapse at three and six years (HR 0.47, 95% CI 0.27 to 0.83,
P=0.0094, and HR 0.22, 95% CI 0.07 to 0.65, P=0.0065, respectively).
With regard to vitamin D genetic variants, Brouwers and colleagues
found that certain genotypes had effects on vitamin D levels, but there
were no further associations with survival or tumor characteristics such
as size, number of positive lymph
nodes, and age at diagnosis.
Brouwers told MedPage Today that the anti-inflammatory effects of
vitamin D are the likely mediator of the relationship between higher
levels and smaller tumor size, though more research is needed to clarify
the exact mechanisms.
She and colleagues called for further research to determine whether
vitamin D supplementation would have beneficial effects on breast
cancer prevention or should be incorporated into standard breast cancer
treatments.
What a wealth of extremely important information. I had NO clue, other than I did run across the correlation between breast cancer and D3 deficiencies. That's why I asked my GYN to test my levels when I was first diagnosed.
It's crazy neither he or my MDA onc felt it necessary to test levels. Crazy. These doctors need to be educated. You'd think they'd know better. I have found through the years not to assume anything though. You MUST be your own health advocate and push for what you know you need.
I was impatient and just ordered the home test version Donna posted. Many thanks Donna, Mainy and others for the education!!
Will let you know my level when I find out. In the meantime I'm supplementing with 2,000 IUs of D3 along w/ magnesium & calcium- all in liquid cap form. I need to look into Vit K too.
I'd sure like to see this thread bumped up to the top of our forum list..
Mindy
Dx July 2011 56 yo Stage I IDC,TN,Grade 3 Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia Daughter also BRCA1+ Mass grew on Taxol FEC 6x better BMX 3/19/12 pCR NED BSO 6/2012
I agree that we have to be our own advocate. I think Vitamin D test should be one of the first things a breast cancer patient has done when diagnosed. I personally think it should be part of our annual exams. We should know our levels just like we should know our blood pressure and cholesterol levels. Just think how many disease could potentially be avoided if we weren't deficient in Vitamin D? I had no idea that my D level was so low when I was diagnosed. So glad you are being proactive and getting tested using the in-home test. I was impatient also and used it to find my levels initially. It took about 2 weeks to get the results. Now my onc includes the test as part of my blood work.
The results of a meta-analysis published online on December 14, 2011 in the American Journal of Clinical Nutrition reaffirm an increased risk of all-cause mortality over follow-up periods ranging from 1.3 to 24 years in association with having reduced serum levels of vitamin D.
Dx July 2011 56 yo Stage I IDC,TN,Grade 3 Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia Daughter also BRCA1+ Mass grew on Taxol FEC 6x better BMX 3/19/12 pCR NED BSO 6/2012
You mentioned you would be looking into vitamin K.
Am sure you will be thorough and also check with your MD (onc and primary).
When one googles " vitamin K" there are some references related to cancer tumors
BUT and it's a big BUT it would seem one would need to be very careful with vitamin
K due to it's role in blood coagulation.
You are probably aware of vitamin K and blood clotting.......but would rather have you
say....yes, I know about that then for me not to post this.
Still marveling at your great response to only 2 chemos of FEC.
Dx July 2011 56 yo Stage I IDC,TN,Grade 3 Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia Daughter also BRCA1+ Mass grew on Taxol FEC 6x better BMX 3/19/12 pCR NED BSO 6/2012
Judy- I was aware of potential blood coagulation and need to research other issues. I'll be very careful. In fact, I decided to hiatus even the B3, calcium and magnesium until my blood work comes back.
Thank you however for posting this to be sure I knew. It's very important and am so grateful to you to make sure I was knowledgeable first.
You're always a beautiful supportive sister. Happy and extremely grateful to be in your company on this forum. You're very special to me.
Love, Best Wishes & Prayers for you. Wishing you a peaceful, joyful holiday receiving the love you've given to so many others.
Mindy
Edited by mindy555 - Dec 21 2011 at 3:55am
Dx July 2011 56 yo Stage I IDC,TN,Grade 3 Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia Daughter also BRCA1+ Mass grew on Taxol FEC 6x better BMX 3/19/12 pCR NED BSO 6/2012
I bought the B-3 (even though I already had some), the magnesium and calcium in separate liquid/gel caps. In haste when purchasing at the Vitamin Shoppe in Houston, I neglected to notice the magnesium is soy based. I plan to see if the soy is acceptable.. though i will probably buy a different formula since the calcium I purchased is quite a high dose. I think I can make a better choice as I explore various formulas.
Any suggestions are welcomed.
Dx July 2011 56 yo Stage I IDC,TN,Grade 3 Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia Daughter also BRCA1+ Mass grew on Taxol FEC 6x better BMX 3/19/12 pCR NED BSO 6/2012
You cannot post new topics in this forum You cannot reply to topics in this forum You cannot delete your posts in this forum You cannot edit your posts in this forum You cannot create polls in this forum You cannot vote in polls in this forum