Medicine For People!

Dr. Rienstra,

I am so impressed with the level of research you must go through to provide the monthly newsletters Medicine-for-People. It is obvious you have a passion to provide medical information to the general public for which no strings are attached. How refreshing is this!

In this day, we are marketed beyond belief. We read and watch only to find that the underlying reason for most information is to sell something. Sometimes I feel we are in the Twilight Zone, with only a few left who can give us information that we need to prevent illness and lead a better quality life. This is not to say that doctors and those in the medical field are trying to take that away from us. I think they are in a survival mode as regulation, insurance and drug companies squeeze every bit of common sense out of them.

What you are offering via these newsletters is a service, and your expertise, experience and willingness to spend huge amounts of time in ongoing research should be compensated. I would be the first paying subscriber.

Thanks again and again,

Judy Peterson
Port Hadlock, WA

March 2004: Vitamin D, Sinusitis and Fungus, Antibiotic Resistance, Prescription Refills

Vitamin D - Clarifying A Controversy

Part Two of a Two-Part Series

In last month's newsletter, we wrote about our need for vitamin D, both from food and from the sun. We cited studies showing that vitamin D is important not just for bone strength, but also to prevent cancer of the prostate and colon and to reduce heart disease and high blood pressure. It may also help strengthen muscles, reduce pain and even help prevent multiple sclerosis.

Recently, too, scientists have noticed that vitamin D seems to modulate the immune system. For instance, give children 2000 units a day of vitamin D starting at the age of one year, and they have only 20% the normal risk of developing childhood diabetes.

Wait, you say, 2000 units. Isn't that too much vitamin D?

This leads us to the second part of our story. How much vitamin D do we require, and how much is safe? Currently the loudest voices in the medical arena say that 200 to 800 units a day is all we need, and that doses over 2000 units per day can be toxic. However, those who study vitamin D recommend up to 4,000 units a day. Why?

Research has shown that a young adult Caucasian exposing her unclothed body to the summer sun will make about 20,000 units of vitamin D within a few minutes. This is ten times the Institute of Medicine's recommended safe maximum dose. Does the Institute know more than Mother Nature about what we need?

My answer is no. Let's look at blood levels of vitamin D. People at the equator run blood levels of vitamin D3 (calcidiol) of 50 nanograms per milliliter. (A nanogram is one billionth of a gram). That fact leads me to agree with the scientists who believe we require a blood level of 35 to 50 ng/ml of calcidiol for optimum health. These are not excessive levels; a lifeguard may run a level of 100 ng/ml at the end of the summer's work. It takes levels above 150 ng/ml to leach calcium out of the bones and cause other abnormalities. Yet many laboratories consider lower levels (down to 12 ng/ml) as adequate. They conclude, incorrectly, that because so many people have these lower levels that such levels are "normal." So, what does it take to get vitamin D levels up to 50 ng/ml? The Institute of Medicine's recommended dose of 400 IU? or a higher dose? According to Reinhold Vieth writing in the American Journal of Clinical Nutrition (2001; 73:288), healthy adults taking 4000 units of vitamin D3 daily maintained blood levels in the safe and desirable range of 50 ng/ml calcidiol. Those taking less just don't get enough. Unfortunately, Vieth's study has simply been ignored

Fear of Toxicity

Why are mainstream medical pundits recommending such low levels of vitamin D? Part of it is a fear of toxicity. It's true that Vitamin D can be toxic in overdose, but it would take a lot. A 150-pound adult would have to swallow more than 100,000 capsules of 1,000 units each to achieve toxic levels. (Ten micrograms of calcidiol is equivalent to a unit of vitamin D2.) Downing that many pills, he would likely die of indigestion and bloating rather than Vitamin D overdose. According to the Vitamin D Council, there are no cases in the medical literature of vitamin D poisoning leading to rapid death. The Council cited one case (cited in PubMed)in which crystalline vitamin D was added to sugar by mistake and two men ingested about 1.7 million units every day for seven months. They both became quite sick, then recovered when the overdose was discovered.

Deficiencies

In truth, the greatest problem with vitamin D in this country is not excess, but deficiency. At a national conference, Dr. William Grant, an epidemiologist, estimated that every year vitamin D deficiency accounts for some 28,000 deaths from cancer among Americans. At the same conference Dr. Kelly Scanlon of the Centers for Disease Control said vitamin D deficiency is a significant health problem, with an estimated 50 percent of African Americans being deficient. For more information click here. Investigation of the vitamin D status of nursing home residents uniformly shows that most are vitamin D deficient. In one nursing home of 104 residents, 99 had undetectably low vitamin D levels. Only one resident was taking supplemental vitamin D.

The primary reason for deficiency is that we don't get enough sun exposure, especially in northern climes, where light levels are low and we bundle up for six months of the year. The widespread use of sun block makes it even harder to get our vitamin D. If you live in northern climes, it's likely you will become vitamin D deficient without supplements or extra exposure to light.

If you want to test your vitamin D levels, two of our laboratories can measure vitamin D in the blood. The price runs from $108 to $244. Your insurance probably won't pay unless they believe the test to be reasonable and necessary. If you are at risk for osteoporosis, prostate cancer, or fat malabsorption, you might benefit from this test.

Fat Absorption Factor

One reason many older people are vitamin D deficient is that they are not absorbing fat. Since vitamin D dissolves in fat, they absorb less of the vitamin D they take in. We regularly see patients who are not aware that they assimilate fat poorly. Now you may look at your love handles and think, "I'm absorbing plenty of fat." The fact is, however, you can make a spare tire out of potatoes and corn. In order to absorb fat, you must have adequate stomach acid, bile juices and pancreatic acid, and many overweight people lack these elements. We can test for stomach acid production and pancreatic acid. If you are not absorbing fat, you may be deficient in vitamin D.

How to Get Enough Vitamin D

The minimal doses of vitamin D recommended by the medical establishment are enough to assure that we don't suffer from rickets, but they are not enough to provide optimal health and prevent disease. Those who study vitamin D believe that a subtle deficiency of the vitamin, over the decades, leads to osteoporosis. There is also good evidence that subtle deficiency contributes to colon and prostate cancer, high blood pressure and other ills. You can get your vitamin D either by using lights or by taking supplements. In next month's article on the sun and your health, I'll talk more about natural sunshine and light therapy. This month, I focus on supplements.

Most people living in the North should consider taking a vitamin D supplement. Several forms of the supplement are available. Vitamin D2 (ergocaliciferol) is made from plant products. Vitamin D3 (cholecalciferol) comes from animal products and is found in cod liver oil and in milk. Cholecalciferol is the form of Vitamin D made in our skin and the one we recommend you take in supplemental form. If you wish to take a vitamin D supplement and do not get blood levels to ensure safety, limit yourself to 4000 units a day.

The old fashioned way to get vitamin D is by taking cod liver oil, which contains about 1200 to 1500 units of vitamin D per tablespoon, along with adequate doses of the major omega-3 fatty acids (1500 milligrams each of EPA and DHA). However please note that cod liver oil contains between 3000 and 3700 units of vitamin A per tablespoon. This amount of vitamin A is alright in itself but, if taken with other vitamin A supplements, could push a woman of childbearing age above the safe daily dose.

Caution - Who Shouldn't Take Vitamin D

People with sarcoidosis, other granulomatous disease such as tuberculosis, cancer (especially lymphoma) or hyperparathyroidism can develop elevated calcium levels even without vitamin D administration, and are especially susceptible to developing high calcium levels with normal blood levels of vitamin D. These people should not take vitamin D without laboratory monitoring and physician oversight. If you develop any unusual symptoms such as atypical thirst while taking vitamin D (or any other supplement for that matter), discontinue it and consult your physician. As you've seen, vitamin D is helpful in a number of medical conditions. However, it doesn't substitute for your doctor's advice.

Sinusitis and Fungus

A few years ago the Mayo Clinic reported that chronic sinusitis was frequently due to an over-response to fungi normally present in the nose. A study in the Journal of Allergy and Clinical Immunology (2002 Dec; 110(6): 862-6) reported that treatment with amphotericin B nasal solution relieved symptoms within a few months in 75 percent of a fifty-patient sample. This is available and we can prescribe it. For more information, click here.

Rant O' The Month -- You don't get resistant to antibiotics

Occasionally someone will say that they are "resistant" to a particular antibiotic. They took it previously, maybe several times, and then it seemed no longer to relieve their ills. So they conclude that they have developed some kind of "resistance" to the antibiotic.

Actually, the miracle of an antibiotic (at least it seemed a miracle in the 1940s) is that these agents will kill bacteria but don't kill us. Not usually, anyway. There are a lot of agents, such as mercury, lead, arsenic, and many others, that will nicely eliminate any bacteria. The trouble is, they eliminate us as well.

So when penicillin came along, we were ecstatic. Penicillin is toxic to the membrane surrounding certain bacteria, but not to our membranes. If you take it, your staphylococci head for the funeral home, while you head off to work and play.

The trouble is that there are a few staphylococci that have the ability to make an enzyme that inactivates penicillin. Send their buddies to the staphylococcal graveyard and they have the whole neighborhood to themselves, so they grow, multiply, and become prosperous. Lo and behold, we can throw all the penicillin in the world at the poor patient who suffers an infection with such a bug, and it doesn't work. Is the patient resistant to penicillin? No, the patient has changed not at all. In fact, if that patient becomes infected with streptococcus, a manly germ that has never resorted to such underhanded tricks such as becoming resistant to penicillin, then we can give the patient a modest dose of penicillin and their strep will die with honors.

So remember, you'll never become "resistant" to any antibiotic, but the bugs can. And that is why you want to save those antibiotics for when you really need them.

Coming Next Month - The Sun and Your Health

In the last two newsletters we've explained how crucial vitamin D is to your health and we've suggested you get out in the sunshine and soak some of it up. Perhaps you've been wondering about skin cancer and all the dire warnings you've heard about that! Next month we examine the risks and benefits of sunshine to your health.

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Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.