vitamin d

Pharmacogenetics:

http://www.ornl.gov/sci/techresources/Human_Genome/medicine/pharma.shtml

 

Thank you, Katniss. The amount of vitamin pushing I read around here greatly concerns me as I know it can cause detrimental effects, but I could never had articulated it as well as you did.

 

I am reading The End of Illness by Dr. David B. Argus. I am finding it interesting.

http://davidagus.com/2012/10/vitamins-prevent-cancer-not-so-fast-new-study-and-headlines-grossly-misleading/

 

* Dr. Agus not Argus!

 

This is all very interesting.

I recently read an article in a medical journal that the key to good immune was Vitamin A, E and Bioflavonoids.

It did not mention anything about supplements and vitamins it was just pertaining to diet.

 

Excellent article. Thanks, Rose. I've copied and pasted it:

VITAMINS PREVENT CANCER? NOT SO FAST.
BY DAVID AGUS, MD ON OCTOBER 18, 2012 LEAVE A COMMENT

If you know about my stance on vitamins and supplements, then today’s headline might have made you scratch your head: “Multivitamins may prevent cancer in men.”

In my book The End of Illness, I make a strong case against them. And for good reason: all of the data thus far has pointed to the potential hazards of taking a daily multivitamin and loading up on supplements, especially those that deliver mega-doses. So you can imagine the response I got today when I learned of this new study published in none other than the Journal of the American Medical Association that seemingly contradicted not only my perspective but the results of countless other respectful studies performed under the rigors of the scientific method (double-blind, placebo-controlled studies).

The gist of this latest study is this, as summarized by CNN: Scientists at Brigham and Women’s Hospital and Harvard Medical School recruited nearly 14,641 male physicians, 50 years or older, and followed them for more than a decade. Half took the daily multivitamin Centrum Silver; the others took a placebo.

Men in the vitamin group had a modest 8 percent reduction in cancer cases compared to the others.

I can hear the resounding Wow! BUT… please read on.

For the lay reader of the summary splashed all over the Internet today like a momentous discovery for medicine, it’s easy to take this study at face value as a logical reason to start taking a multivitamin. Before you pull out your wallet, let me point out a few things that I notice in studies like this, and which has everything to do with a critical reminder I love to give: scrutinize data before accepting it as dogma. In other words, read between the lines:

For starters, the study showed only a moderately reduced risk of cancer (8 percent relative risk reduction, or about 1 percent absolute risk reduction) in men at least 50 years old. A small statistical reduction, indeed, and it cannot say anything about any other groups of people, including women.
The people who showed signs of this reduced risk in total cancer had a history of cancer. Perhaps if you are cancer-free, there’s no reason to take vitamins; if you have a history of cancer and you’re a man over 50, perhaps it’s a conversation to have with your oncologist.
The study showed no significant difference in cancer mortality (i.e., the risk of dying from cancer), but when you consider other studies in this realm, the trend is in the direction of increased mortality with vitamins. Put another way, your risk of dying is greater if you take vitamins. (For a comprehensive review of the evidence suggesting potential harm from vitamin use, see chapter 7 of my book.)
The participants in the study were willing to forgo the use of multivitamins or individual supplements containing more than 100 percent of the RDA for vitamin E, C, beta carotene, or vitamin A. So their intake of supplements was (partially) controlled. What’s more, those taking the vitamins were given a normal dose of Centrum Silver. This study cannot say anything about mega-doses, which reflect a lot of people’s habit today when it comes to vitamins.
A large majority of the participants in the study had been part of an earlier study looking at the link between taking a daily baby aspirin and cardiovascular disease. We know now that aspirin is a strong anti-inflammatory with anti-cancer effects. How could the researchers have factored out such effects from the aspirin in reducing the risk for cancer?
Bottom line: We need more studies performed. I’m all for changing my position when there’s enough data to make the case. We must put this study in a meta-analysis context with previous studies and ask ourselves, What does the big picture look like? One study doesn’t resolve the big picture. It’s unfair and misleading for the media to report on this study with a blanket headline like “Multivitamin Cuts Cancer Risk, Large Study Finds” (the Wall Street Journal’s version). Such grossly generalized statements prey upon the lay public’s inexperience with digesting scientific data, purported results, and implications and applications to each person’s own individual life.

When you read a headline like this, it’s natural to gravitate toward an overly-simplistic conclusion: vitamins prevent cancer—in everyone. Period. But if I came to you and said I just did a study demonstrating that low-dose multivitamins reduce one case of cancer in 100 people—and only in men over 50 who previously had cancer—how would that change your opinion?

Of all the health ideas I’ve given over this past year, the anti-vitamin one seems to ruffle the most feathers, especially among opponents of my view. I still don’t know why some see me as “controversial” when I back my claims with sound science. I should add that when other doctors were interviewed about this particular study (doctors who, like me, were not a part of the study), they shared similar reactions reported in the media:

“It will be difficult to make generalizations to the broad public from this one study…” said Dr. Ernest Hawk, vice president and division head for the Division of Cancer Prevention & Population Sciences at MD Anderson Center in Houston, Texas. He then went on to say that reducing cancer risk may not necessarily be garnered from a pill but rather by living healthy: eating right, getting plenty of exercise and not smoking.

Amen to that!

 

Has anyone heard of the famous Irish comedian Dara O Brian? He was a highly respected scientist but now turned comedian, also has a show on BBC called mock the week.
I was watching it last night and he was having a right go at "naturopaths" and "vitamin pushers". it went like this: "naturopaths and vitamin pushers like to stand on their high moral ground and make statements like 'science does not know everything you know', well of course science does not know everything otherwise it would STOP...!
Its probably on youtube, very funny.

 

Have I heard of him?? He's only one of my favourite comedians, ever! Is this the clip you mean? http://www.youtube.com/watch?v=DHVVKAKWXcg

I'm not over stating it when I say I've watched it literally dozens of times. Feckin' hilarious and spot on!

 

Those concerned about vitamin D toxicity should read two recent papers on the subject, here:
http://www.ncbi.nlm.nih.gov/pubmed/22536776

and here:
http://www.ncbi.nlm.nih.gov/pubmed/23094916

A summary of cogent facts in the second article (extracted from this URL: http://blog.vitamindcouncil.org/2012/12/18/vitamin-d-safety-risks-and-benefits-of-fortification-and-supplementation/) is as follows:

1. Data on skin synthesis of vitamin D indicate oral intake of 10,000 IU/day is safe.

2. The half-life of 25(OH)D3 is about 3 weeks. That is, it takes about 3 weeks for the body to metabolize one-half of a dose of vitamin D. However, this depends on initial levels, the lower the initial level the longer the half-life.

3. Vitamin D intoxication is rare, while vitamin D deficiency is widespread and a “re-emerging global health problem.”

4. Excessive vitamin D intake leads to low blood phosphate levels.

5. Vitamin D toxicity is probably caused by the effects of elevated 25(OH)D itself, not by elevated 1,25(OH)D levels.

6. Professor Hector DeLuca of the University of Wisconsin, recently concluded that high blood calcium might occur in some people after prolonged daily doses of 25,000 IU/day.

7. 10,000 IU/day for six months in young men led to mean 25(OH)D levels of 90 ng/ml.

8. 5,000 IU/day for six months in young men led to mean 25(OH)D levels of 53 ng/ml.

9. Dr John Hathcock’s analysis of 20 publications showed no ill effects of using 10,000 IU/day.

10. Most reports indicate the toxicity threshold is somewhere between 10,000 and 40,000 IU/day.

11. High intermittent doses of vitamin D, such as monthly doses, should be avoided.

12. A high initial serum 25(OH)D level somehow allows the body to rid itself of most of an additional dose of vitamin D.

13. When 25(OH)D3 is used as a drug, it is five times more potent than vitamin D3. It used to be available in the USA as Calderol and Delakmin.

14. According to the Institute of Medicine’s Food and Nutrition Board, the upper safe blood level for 25(OH)D is 50 ng/ml. However, according to Dr Zimmermann, this recommendation “is not well documented.” Certainly, much higher levels are seen with sun exposure alone.

15. How much vitamin D one needs depends on body weight, with 20-40 IU/kg/day needed to increase blood levels by 20 ng/ml.

--John of Ohio

 

I love that guy. He is hysterical!!!

 

The first two links are just abstracts, so it's hard to tell what the study design was or how the researchers came to their conclusions. Titles and headlines are often misleading. But neither abstract was conclusive or particularly convincing.

As for the rest of the safety statements you posted, what studies are they based on, who made these statements, and most importantly what was the time period that the subjects were followed for? Six months? A year? Oftentimes it's even less. That's usually a significant weakness of these types of studies: they are too short.

John, I'm with you to a degree - on a public health level, improved vitamin D levels may produce a healthier population. And, yes, some individuals might see a significant health improvement. It's probably worth any of us trying to get our numbers up if they're low, but I don't think any of the good scientists and researchers doing this work would say without hesitation that their work is conclusive or that there is still much to learn about the long-safety and efficacy of taking vitamin D at high doses indefinitely which is what you seem to be proposing.

I find it very hard to believe that there is NO RISK associated with taking any supplement, especially at high doses for long periods of time. Just because a specific risk has yet to be identified (though I'm sure some have), doesn't mean it doesn't exist. It just means we don't know about it.

 

I meant: or that there is NOT still much to learn about the long-term safety...

 

But, do you believe that 5000 IU/day is a high dose that puts users at risk? If so, what is the clinical or published data supporting that claim?

I don't promote "high doses" of vitamin D. Just 5000 IU/day, as do a large body of MDs and PhDs who have studied the matter in the greatest detail and have clinical experience and evidence of efficacy (and safety).

If you are concerned about "risk," would you take any prescription drug, most of which have a giant insert cautioning against all the risky side effects, along with more detailed pages of cautions in the PDR ("Physician's Desk Reference")?

Can you tell us of any normal human activity (or food or drug) that has "NO RISK?"

You are certainly welcome to limit yourself to 2000 IU or less, and remain "safe." I'll continue to pop 5000 IU with breakfast each morning, and continue to be free of colds and influenza episodes (as I have been for several years now on vitamin D). I sleep better, have no winter blues (SAD, seasonal affective disorder), and my chances of prostate (and other) cancers, obesity, diabetes, and cardiovascular diseases---all of which show inverse relationships to serum vitamin D levels---are statistically reduced. The risks of any of those far exceed the mysterious and undocumented other risks that are implied in your NO RISK statement.

There is a diversity of opinion and practice regarding every medical matter, as with both vitamin D (and other vitamins, minerals, and supplements), and most illustratively on this website, with Meniere's Disease and its kindred afflictions. (Talk about treatment risks!!)

--John of Ohio

 

JoH:

As a casual observer of this thread, how many pills do you pop a day and what are they?

 

Question

Vitamin D toxicity: What if you get too much?
What is vitamin D toxicity, and should I worry about it since I take supplements?

Answer
from Katherine Zeratsky, R.D., L.D.

Vitamin D toxicity, also called hypervitaminosis D, is a rare but potentially serious condition that occurs when you have excessive amounts of vitamin D in your body.

Vitamin D toxicity is usually caused by megadoses of vitamin D supplements — not by diet or sun exposure. That's because your body regulates the amount of vitamin D produced by sun exposure, and even fortified foods don't contain large amounts of vitamin D.

The main consequence of vitamin D toxicity is a buildup of calcium in your blood (hypercalcemia), which can cause symptoms such as poor appetite, nausea and vomiting. Weakness, frequent urination and kidney problems also may occur. Treatment includes the stopping of excessive vitamin D intake. Your doctor may also prescribe intravenous fluids and medications, such as corticosteroids or bisphosphonates.

Taking 50,000 international units (IU) a day of vitamin D for several months has been shown to cause toxicity. This level is many times higher than the recommended dietary allowance (RDA) for most adults of 600 IU of vitamin D a day. Doses higher than the RDA are sometimes used to treat medical problems such as vitamin D deficiency, but these are given only under the care of a doctor and only for a short time.

Although vitamin D toxicity is uncommon even among people who take supplements, you may be at greater risk if you have health problems, such as liver or kidney conditions, or if you take thiazide-type diuretics. As always, talk to your doctor before taking vitamin and mineral supplements.

 

Too Much Vitamin D Could Be Harmful to Heart
HealthDay - Tuesday, January 10, 2012


TUESDAY, Jan. 10 (HealthDay News) -- Studies have shown that vitamin D is critical for bone health and could have a protective benefit for the heart, but new research suggests that too much of it could actually be harmful.

"Clearly, vitamin D is important for your heart health, especially if you have low blood levels of vitamin D. It reduces cardiovascular inflammation and atherosclerosis, and may reduce mortality, but it appears that at some point it can be too much of a good thing," study leader Dr. Muhammad Amer, an assistant professor in the division of general internal medicine at the Johns Hopkins University School of Medicine, said in a Hopkins news release.

In conducting the study, published in the Jan. 15 issue of the American Journal of Cardiology, researchers examined five years of data from a national survey of more than 15,000 adults. They found that people with a normal levels of vitamin D had lower levels of a c-reactive protein (CRP), a marker for inflammation of the heart and blood vessels.

On the other hand, when vitamin D levels rose beyond the low end of normal, CRP also increased, resulting in a greater risk for heart problems.

"The inflammation that was curtailed by vitamin D does not appear to be curtailed at higher levels of vitamin D," Amer explained.

The researchers concluded that people should be aware of the potential risks associated with taking supplements, particularly vitamin D.

"People taking vitamin D supplements need to be sure the supplements are necessary," Amer said. "Those pills could have unforeseen consequences to health even if they are not technically toxic."

It is unclear why higher levels of vitamin D are not beneficial for the heart, the researchers said.

More information

The U.S. National Institutes of Health provides more information on vitamin D.

 

Bulldogs,

Thanks. This, for the first time here, posts an actual threshold number for vitamin D ingestion toxicity. Of course, what peer-reviewed journal this datum originated in is unstated, but we can presume it’s accurate, can we not?

If so, I’ll have to pop 10 of my 5000 IU vitamin D softgels each day, “for several months,” before I’m at risk. My vitamin Ds come in bottles of about 120, so I’ll have to run down to the vitamins shop about every 12 days, for several months, to get to a level of toxicity.

I could try to pop all 10 with my breakfast; or, I could pop one softgel about every hour and a half through the waking day.

None of my friends—as strange as some might be—aren’t too likely to adhere to this regimen. Makes no sense whatsoever. It’s stranger than taking statins (check the side effects, toxicity, on those!).

Your next posting states no numerical levels of imputed or measured or recorded vitamin D toxicity. Like many other postings on this thread, it’s pure guessing and presumption, unsupported by any peer-reviewed journal articles or other reliable hard data, without numerical levels of toxicity of any form.

And the world is going to end in a week, too. The Mayans said so.

–John of Ohio

 

Tell me what you think the difference is between taking a drug at therapeutic doses and any VMS at therapeutic doses. There is none. Substances we label as drugs in this country must be manufactured under certain conditions and their claims are regulated. They are prescribed and dispensed by highly educated and licensed practioners. When a pattern of negative events occur, it is more likely to be observed and safety reviewed.

On the other hand, anyone with little or no formal education in science or medicine can promote and sell supplements to the general public with no knowledge or understanding of chemistry, physiology or pharmacology or of the person's health history or individual risk factors. And investigation after investigation has found serious concerns related to contamination and actual dosages found in supplements due to complete lack of regulation or an effective tracking system for negative events/side effects (therefore they go largely unreported).

I do not believe it is safe to take any dietary supplement indefinitely. Despite your citation of multiple studies on this subject, I continue to argue that the long term safety and efficacy of taking vitamin D at the dose you are recommending for an indefinite period of time has in no way been proven safe and effective. I won't tell people here what to do, they are adults who can decide for themselves. But I do feel compelled to offer my professional opinion and urge caution.

It is true drugs do come with inserts listing all the potential risks and side effects. They are required to do so by law so the average person can make an informed decision and also be advised of the early signs of negative side effects. It seems to me that you are proposing that since VMS don't come with such inserts that there are little to no potential for side effects. Well that is simply not true. The supplement industry is not required to prove safety or efficacy, nor is it required to warn or information consumers of potential risks, short term nor long term.

Btw, there is inherent risk in eating the same foods day after day indefinitely. Our risk is minimized by following a varied diet. There is a huge difference between getting nutrients and accompanying contaminants from a mixed diet than from a pill.

 

John:

With all due respect, the same article indicates the recommended dose is no more than 600IU and while larger doses may be taken for vitamin D deficiency, they should be done under the care of a doctor, not because somebody proposes it on a mm forum.

It you do not have vitamin D deficiency, the article clearly states recommended dosage of no more than 600IU. If you are goin to do more make sure it is under the watchful eye of a MD.

The articles states 50,000 IU is toxicity (overdose) but what you fail to see is there is a big discrepancy between overdose and harmful.

Anything over 600IU could be harmful long term unless overseen by a Dr.

 

This is an interesting study, with profound implications.

If it’s true, that those with vitamin D levels “beyond the low end of normal,” people who get adequate, or massive amounts of direct, strong sunlight, such as beach life guards, and most people who live in sunny tropical areas of the world, should have elevated “heart problems.” A few minutes or hours in direct summer sun, in a bathing suit, produces at least 10,000 IU of vitamin D in the skin, which after a few weeks of this, would assuredly elevate serum vitamin D levels above “the low end of normal.”

But curiously, I’ve seen no studies indicating that beach-goers, life guards, or people in sunny tropical areas actually have elevated “heart problems.”

We await those findings, do we not?

Of course, here’s a peer-reviewed journal article, a meta-analysis (a statistical examination of multiple previous journal articles) that shows “a generally linear, inverse association between circulating 25(OH)-vitamin D ranging from 20 to 60 nmol/L and risk of CVD.” “Inverse association...” That means (for those unfamiliar with bio-statistics) that those with more vitamin D had less CVD (cardiovascular disease).

These authors weren’t just making up numbers. They scrutinized 24 previous journal articles, with several dozens of professional scientists as authors.

Read it for yourself, here:
http://www.vitamindwiki.com/Cardiovascular+disease+50+percent+more+likely+if+low+vitamin+D+%E2%80%93+meta-analysis+Nov+2012

I remain convinced. More vitamin D, up to 100 ng/ml in the blood, is better for the heart. The journal evidence for this is overwhelming (in journal articles with real studies and numbers, not “opinions”).

–John of Ohio