PRESS RELEASE
November 25, 2003
FOR IMMEDIATE RELEASE
The Vitamin D Council
9100 San Gregorio Road
Atascadero, CA 93422
805 462-8129
http://www.cholecalciferol-council.com
jjcannell@charter.com
VITAMIN D LOWERS C-REACTIVE PROTEIN (CRP)
Van den Berghe and colleagues at the University of Leuven in Belgium appear to be the first to show that simple, natural and cheap vitamin D (cholecalciferol) lowers CRP in critically ill patients. Even small amounts of cholecalciferol (500 IU) lowered CRP by more than 25% in a small group of critically ill patients. Another marker of inflammation (IL-6) was reduced even more. The researchers also found that critically ill patients were profoundly deficient in vitamin D.
Last year, Timms and colleagues at the University of London showed that vitamin-D deficiency is associated with increased circulating CRP in otherwise normal subjects and appear to be the first group to show CRP was lowered by simple vitamin D. As vitamin D deficiency is associated with numerous illnesses with inflammatory components, such as hypertension, heart disease, diabetes, autoimmune illness and , the findings were important. The authors concluded, "This finding provides a possible mechanism for tissue damage in chronic inflammatory conditions, including CHD and diabetes."
CRP may be as important as cholesterol. http://www.alpco.com/indnews/0305ahacdc.asp Unlike cholesterol alone, cholesterol and CRP together predict a substantial number of cases of heart disease.
Physicians currently use the statin drugs to reduce CRP but the reduction by statins is often modest.
Van den Berghe's findings show that vitamin D deficiency is widespread among the critically ill and suggest that that vitamin D deficiency may contribute to the inflammatory basis of various illnesses. For example, earlier this year, Zittermann of the University of Bonn, studied patients with congestive heart failure and found elevated levels of TNF, another marker on inflammation. He also found critically low levels of calcidiol [25(OH)D], the only reliable marker of vitamin D nutrition. He even found low levels of calcitriol, the active form of vitamin D that is usually decreased in only profound vitamin D deficient states. Zittermann concluded vitamin D deficiency "can explain alterations in mineral metabolism as well as myocardial dysfunction in the CHF patients and it may therefore be a contributing factor in the pathogenesis of CHF."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12570952&dopt=Abstract
Animal models have repeatedly shown that calcitriol has anti-inflammatory properties but the above two groups have now clearly expanded that finding by studying simple vitamin D in human subjects.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10200452&dopt=Abstr act
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12548714&dopt=Abstr act
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12051670&dopt=Abstract
It is important to note that vitamin D's anti-inflammatory actions in humans were long suspected as studies of the patentable analogues showed anti-inflammatory actions. For example, several studies, using analogues, such as 1 alpha (OH) D3 (alphacalcidiol), have previously been shown to significantly reduce CRP and improve patient outcome, when given to human patients suffering from rheumatoid arthritis, but similar studies using physiological doses of natural vitamin D have never been done.
Heaney and his colleagues have recently shown that humans, in the absence of sunlight, need up to 5,000 IU of cholecalciferol to maintain adequate calcidiol levels (35-55 ng/ml). He further showed that doses of vitamin D, up to 10,000 IU a day were safe when given orally, a fact that should surprise no one given the extraordinarily rapid and substantial cutaneous production of vitamin D. However, physiological doses of vitamin D have rarely been used therapeutically in humans and, to our knowledge, have never been studied to see how much they can reduce CRP. That is, If 500 IU can reduce CRP by 25%, what would 5,000 IU do?
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12499343&dopt=Abstract
Therefore, after reading Van den Berghe's study, we are left wondering (like in so many other areas of vitamin D and human health), "what if physiological doses of vitamin D had been used?" However, some good news is on the horizon. We know of one ongoing academic study in Romania that will answer some of these questions. It is being sponsored by Paul Stitt, owner of Natural Ovens Bakery of Manitowoc, WI. A large group of elderly patients will receive 10,000 IU of ergocalciferol (equivalent to about 6500 IU of cholecalciferol) in bread and will then be followed by multiple physical and laboratory parameters, including CRP. Similar studies have been difficult to do in the past, at least in the USA, due to inaccurate toxicity information (NOAEL and LOAEL) produced by the 1997 Institute of Medicine's Food and Nutrition Board.
Prominent vitamin D scientists who are speaking out about vitamin D deficiency:
Dr. Hector F. DeLuca
Department of Biochemistry
University of Wisconsin-Madison
433 Babcock Drive
Madison, WI 53706-1544
Phone: 608-262-1620
Fax: 608-262-7122
Email: deluca@biochem.wisc.edu
William Grant, PhD
(Epidemiology)
12 Sir Francis Wyatt Place
Newport News, VA 23606-3660
Phone: (757) 599-9811
Email: wbgrant@infionline.net
Robert Heaney, MD
Osteoporosis Research Center
Department of Medicine
Creighton University Medical Center
Omaha, NE 68131
Phone: (402) 280-4029
Email: rheaney@creighton.edu
Michael Holick, PhD, MD
Vitamin D Laboratory
Department of Medicine
Boston University Medical Center
715 Albany St. M-1022
Boston, MA 02118
Phone (617) 638-4545
Fax 617-638-8882
Email: mfholick@bu.edu
Bruce Hollis, PhD
Departments of Pediatrics
Medical University of South Carolina
171 Ashley Ave.
Charleston, SC 29425
Phone (843) 792-6854
Fax (843)792-8801
Email: Hollisb@musc.edu
Tony Norman, PhD
Department of Biochemistry
Room 5456 Boyce Hall
University of California
Riverside, CA 92521
Phone: (909) 787-4777
Fax: (909) 787-4784
Email: anthony.norman@ucr.edu
Reinhold Vieth, PhD
Pathology and Laboratory Medicine
Mount Sinai Hospital
600 University Ave.
Toronto, Ontario, Canada, M5G 1X5
Phone (416) 586-5920
Fax (416) 586-8628
Email: rvieth@mtsinai.on.ca
About vitamin D:
Vitamin D is a vital nutrient that is unique, both in terms of its physiology and human reliance on both endogenous skin production and exogenous sources to meet biological requirements. Vitamin D is commercially available as Vitamin D3, (cholecalciferol) made from animal products, and vitamin D2, (ergocalciferol) made from plant products.
Cholecalciferol is also made naturally by the action of a specific wavelength of ultraviolet light (UVB) in the skin which is then turned into calcidiol [(25(OH)D] by the liver. In turn, the kidney makes and then excretes the steroid calcitriol into the blood to help regulate calcium in the body. This is the main endocrine function of vitamin D.
Meanwhile, many tissues other than the kidney turn calcidiol into calcitriol to help regulate gene expression locally; this is the newly discovered autocrine (inside the cell) and paracrine (surrounding the cell) functions of vitamin D. This autocrine and paracrine function is impaired in vitamin D deficient subjects and all studies show many Americans are vitamin D deficient, especially Blacks. This use of calcitriol by other tissues as an autocrine and paracrine hormone is a relatively new discovery that explains its role in human development as well as the many health benefits of vitamin D such as prevention or treatment of diabetes, hypertension, heart disease, autoimmune illness, various cancers and, perhaps, some mental illness, to name a few.
The single most important scientific fact about vitamin D is that young adult Whites make about twenty thousand units of vitamin D in their skin within minutes of whole-body, summer-sun. This is one-hundred times the Adequate Intake (AI) recommended by the federal government's FNB for young adults. Therefore, many Americans greatly exceed the federal government's safety recommendations by simply spending a few minutes outside in their swimming suits! This extraordinary rate of natural vitamin D production in the skin (20,000 IU) leading to the production of an endocrine, paracrine and autocrine steroid hormone leads one (as
T.S. Eliot once said), "to an overwhelming question." Why did Nature design such a complex system resting on bountiful natural skin production of cholecalciferol? Answer, "Probably for a very good reason."
Because low calcidiol [25(OH)D] levels (less than 35 ng/ml) are associated with so many chronic illnesses, calcidiol levels are an important part of any laboratory health evaluation and should be routinely checked by physicians. Unfortunately, few physicians are aware of this so perhaps as much as 70% of the U.S. population has calcidiol levels below 35 ng/ml. Even when asked to check vitamin D levels, physicians often order calcitriol levels, instead of calcidiol levels, an error which misleads both the physician and the patient.
Healthful blood levels of calcidiol [25(OH)D] are between 35 and 60 ng/ml although commercial labs usually report "normal" or Gaussian distributions of between 8-72 ng/ml depending on the latitude of the lab's population. Therefore, commercial reference laboratories also mislead physicians and their patient by reporting "normal" (Gaussian distributions of a deficient population) instead of healthful calcidiol levels. Patients need to know these facts before asking their physician for the calcidiol [25(OH)D] blood test. Until the medical profession becomes educated on this matter, patients need to become educated, educate their physicians, get the proper blood test and then take steps to obtain healthful calcidiol levels.
Persons with low calcidiol levels have three choices: the sun, a sun lamp or supplements. At most latitudes in the USA, little or no vitamin D is made in the skin in the late fall and early winter. In northern states the vitamin D blackout lasts for about six months. In the spring and summer, whites can make large amounts (20,000 IU) by sunbathing on both sides, without sunblock, for a few minutes (about 1/3 the time it takes for you skin to begin to slightly redden). Darker skinned persons up to 10 times longer depending on the amount of melanin in the skin. Vitamin D production occurs within minutes and is maximized long before skin turns red or begins to tan. One does not have to get repeated blood tests when using sun exposure to obtain vitamin D because toxicity can not occur even with heavy and continuous sunbathing as ultraviolet light degrades vitamin D after making about 20,000 IU, thus reaching a steady state. HOWEVER, overexposure, especially sunburns, is damaging to the skin, dangerous, and should be entirely avoided.
Some sunlamps contain significant amounts of UVB and have been shown to raise calcidiol levels into the healthful range and also have the benefit of not having to worry about toxicity or obtaining repeated blood levels. Again, care must be taken not to overexpose the skin.
Many people are beginning to rely on supplements to raise their calcidiol levels as they have been told (usually erroneously) to avoid the sun entirely. However, in the absence of any sunlight, one must consume 3,000 to 5,000 IU of cholecalciferol a day to maintain healthful calcidiol levels. Similar studies have not been done with ergocalciferol but current data indicates that even more ergocalciferol would be needed. Vitamin D repletion is best done under a physician's care so calcidiol levels (and perhaps calcium levels) can be monitored. Persons diagnosed with sarcoidosis, other granulomatous disease, cancer (especially lymphoma) or hyperparathyroidism should not take vitamin D unless they are under the care of a knowledgeable physician (and would be well advised to find one). Patients with these conditions may develop vitamin D hypersensitivity syndrome which is different than vitamin D toxicity.
Persons who do not want to have blood tests would be best advised to rely on prudent sun exposure. If such persons choose to avoid the sun, they should never exceed 2,000 IU of cholecalciferol a day which is the Institute of Medicine Food and Nutrition Board's NOAEL (No Observed Adverse Effects Level).
Cod liver oil contains about 1200 IU of vitamin D per tablespoon but also contains about 14,000 IU of vitamin A. Therefore, persons with no sun exposure may exceed safe intakes of vitamin A in order to replete the vitamin D system. (We know omega-3 nutrition is very important but believe fish oil to be a safer alternative than cod liver oil).
Vitamin D can be toxic in overdose (probably more than 20,000 IU a day over a prolonged period of time). We are not aware of any reports in the literature of deaths from acute overdose, such as a suicide attempts, leading to death. In fact, a 150 pound human would have to take about 100,000 capsules of the 1,000 IU cholecalciferol capsules to approach the LD50 for the most sensitive mammal (the male rat at 40 mg/kg).
Such patients would be more likely to die from gastric bloating leading to asphyxiation than from vitamin D toxicity! In mammals, signs of toxicity short of death can first be seen at .5mg/kg (20,000 IU/kg or 1,400 capsules at one time for a 150 pound adult human). We are unaware of any reports of vitamin D toxicity from supplements except when manufacturing errors occurred. Most of the reported toxicity is industrial (dairies putting in the wrong amount into milk or the concentrated oil being used for cooking). However death from chronic poisoning has been described and is possible. If you believe "if little is good then a whole lot is better," then you may discover the inverse association between bad judgment and natural selection.
About The Vitamin D Council:
The Vitamin D Council is a group of citizens concerned about vitamin D deficiency and the diseases associated with that deficiency. (We have recently changed our name from the Cholecalciferol Council to The Vitamin D Council after finding out most people cannot pronounce "cholecalciferol," and after learning that cholecalciferol is not kosher).
The Vitamin D Council will attempt to draw attention to the problem of vitamin D deficiency through the education of professionals, the media, government officials and average citizens. The Vitamin D Council is a nonprofit entity incorporated under the laws of California under the name Cholecalciferol Council. We are in the process of applying for tax-exempt, non-profit [501(c)(3)] status as an educational organization under the laws the United States. We currently have no funding but will apply for grants if our [501(c)(3)] status is granted. We will not accept donations or grants from individuals or organizations whose goals may conflict with ours. The Executive Director of The Vitamin D Council is John Jacob Cannell, MD. Details of his background are available on the Council's web site, http://www.cholecalciferol-council.com/ or via email at jjcannell@charter.net.