Vitamin D Gets a Reality Check, Or Does It

March 01, 2015

Vitamin D Gets a Reality Check, Or Does It 

 Reference:   Annals of Internal Med 2015, Washington Post 

 The US Preventative task force is waving a bit of a caution flag out there about Vitamin D. They state that, as best as they can tell, there really isn’t “convincing” evidence that “megadoses” of Vitamin D are helpful.   Certainly, we feel ok about getting extra for bone health.   By extra, the Institute of Medicine, which essentially is the governing body for what is in a vitamin pill or standardized recommendations, has stated that there is little usefulness for more than 800 IU of extra D a day. They also acknowledge that below 20 ng is a problem and should be repaired. 

But the evidence for more than 4000 IU a day might be skimpy.   More concerning is the worry that high doses might lead to extra kidney stones and calcification in arteries, just what we thought we might be avoiding by taking more. There is research out there about larger doses that is currently being conducted. We will get those results sometime in 2017 or 18, so, it’s still a ways off. Until then, what to do? 

 Here are some of my thoughts.   First of all, humans with mid-European skin type III (most Germans, English, French, Poles – who can tan but burn with too much sun) make about 1,000 IU a minute when exposed to mid-day sun in June at age 20. That means we are being advised to have only 36-48 seconds of direct sunlight a day extra. Anything more than that might be dangerous. Hmmm. 

 I also know that the Journal Science published an article in 2006 that shows that our own natural antibiotic, cathelicidin, is not manufactured until we have a blood level of 32 ng.     It staggers my imagination that we want you to have your own immune system less than that.   In 2008, Smith in the Am J or Clin Nutrition showed that in Antarctica, 2000 IU of Vit D only got your blood level to 29 ng (or 72 nmoles).   In Wisconsin, we know that our D level drops to around 15 ng in winter. In Antarctica, on no D, it drops to 14 ng (34 nmoles) , so being in Wisconsin is just like McMurdo Sound research station. (Disagree?) My suspicion about the errors in this editorial is somewhere in the middle of all of this recommendation conflict and anxiety.   I do know that there is abundant evidence that Vitamin D administration for decades to infants results in 78% less insulin-dependent diabetes 30 years later.   2000 IU to babies!   The Institute of Medicine would fall off their rockers in horror.   But explain to me the epidemic of insulin-dependent diabetes we have here in Wisconsin African Americans, whose D is even lower than Caucasians, or the epidemic of Multiple Sclerosis we have in the upper Midwest compared to the South or tropical countries. But that’s just epidemiology and not a clinical trial. And that’s where I think this sort of recommendation breaks down. You can’t do controlled trials of populations comparing the administration of a drug with no side effects, that last 30 years. Just too expensive. Takes too long. No patience. I am worried about kidney stones. 

 WWW. What will work for me? I’m anxious about kidney stones. I’ve had 4 clients who have had them. I’ve had them. But so have 8.8% of the population. I’m also worried about MS, and tuberculosis, and influenza, and cancer. But my judgment is that the fatal flaw is in the effort to apply the pure scientific method. Heaney helps understand that long-latency diseases might need another approach. In the meantime, I haven’t seen an epidemic of kidney stones each summer when we get more than 48 seconds of sunshine.   What I would give for just 15 seconds right now. Bottom line. I want you to have at least 32 ng.   Optimal? Yet to be determined.   Pop Quiz.

  1. Our current recommendations of Vitamin D supplementation involve getting how many seconds of sunshine a day?   A) 12   B) 24   C) 36   D) 72   E) 600                     Answer:  C for most adults, D for over age 71 
  2.  In Finland, a study of newborns given 2000 IU of D a day for their childhood resulted in how much less insulin-dependent diabetes?                          Answer:   78% 
  3. The Journal Science showed that your immune system doesn’t kill tuberculosis until your D level is at least   ________?                          Answer:  32 ng. 
  4.  A 20-year-old Caucasian with skin type III (Can tan, but also can burn), with 20 minutes of mid-day sun on the 20th of June will make how many IU of D a minute? 1000 
  5. Long latency diseases like MS and insulin-dependent diabetes might be dramatically reduced by sufficient Vitamin D. T or F True 
  6. To prove that D works or doesn’t work, we need a randomized placebo-controlled trial that lasts 30 or more years – something that will never happen. T or F True. It will never happen. We need a different method. 
  7. If these risks were true we should observe epidemics of kidney stones every year after Summerfest when folks get too much fun and too much sun.  T or F.          Answer: You answer that one.