April 24, 2011- published April 19, 2011 in the British Medical Journal a meta-analysis of 36,282 postmenopausal women given calcium or calcium with vitamin D found higher incidence (slight but there nonetheless) of MI (myocardial infarction) with or without stroke. The researchers could not determine the exact cause but suggest the acute rise of calcium after supplementation may be a problem as both high and low dose calcium with or without D were implicated. From the study-
"...This would be consistent with the notion that the abrupt change in plasma calcium concentration after supplement ingestion causes the adverse effect, rather than it being related to the total calcium load ingested."
Please make sure, if you do take calcium, as suggested in the Workbook and Preliminary Report, take small amounts throughout the day with food. Also consider that minerals are best in combination, not as singular elements, and consider that vitamin K, minimum daily dose 1 mg. (1,000 mcg), is critical to the health of both heart and bones keeping calcium in bones and out of soft tissues (such as arteries). This information is also in both the workbook and report.
April 2011 A phone call this week is worth posting. A women working with a physician tested 25(OH)D at 36 ng/ml (optimal 40-60 ng/ml) about 3-4 months ago. Her physician told her to take 20,000 IU vitamin D daily. This week she tested 157 ng/ml. Her physician said lots of her patients tested that high and there is no problem and that she should reduce her dose to 5,000 IU. The woman asked my advice. First I suggested she find another physician. Then I suggested she stop all D and sunlight, and lower her calcium intake, until her 25(OH)D reached below 60 ng/ml. I have no idea how long this will take.
If this is your physician or if your physician is like-minded I suggest you, also, get another physician. I also suggest you pay attention to all future health problems and record them chronologically. Report your physician to your local medical board. As I have stated here and in my book there are consequences when ingesting excess vitamin D though among D enthusiasts not yet accepted. One possible consequence is demineralization of bone and/or mineralization of soft tissues. This may happen without any unusual blood work, serum calcium remaining normal. It has been documented by Adams, Kummerow, and Kartha. There are other possible consequences. I will post more later.
The partial article below may be found in full here. What it demonstrates is that D and minerals do not work alone. Just getting enough D and/or calcium is NOT an answer.
protects, maintains healthy bone mass Dipali Pathak
I have had several clients over the years with more than adequate vitamin D (between 48-59 ng/ml) and breast cancer. And the studies regarding the reversal of breast cancer with vitamin D were about analogs (artificial molecules created in a lab) used on cancer cells not in actual women. I visited one site proposing such nonsense and read that the ideal amount of 25(OH)D is 60-80 ng/ml and again NO it is not. In our fast times we seem to misread the research and project miracles where they do not exist. I am saddened by the misuse of research and am at a loss to understand why this is occurring. We need vitamin D. When we have between 40-60 ng/ml we are healthier, maybe even happier, but it won t prevent or cure anything, clinically, except secondary hyperparathyroidism and rickets.
Vitamin D with or without calcium has not even been that great at preventing or reversing osteoporosis. There are just too many other things we need to be healthy to lump it all on this one thing . When will we give up the magic bullet? persons promoting high dose and high serum D for the prevention of cancer or any other specific disease really don t understand the human body or vitamin D. Do listen to them with caution, please. And it is true, really, too much D is as unhealthy as too little. Enthusiasm seems to blind us to logic and common sense.Questions and Answers:
Question: Do I have to worry about not getting enough UV-B exposure (for Vitamin D), during the winter, since I live in Denver, which, obviously is 5,280 above sea level? I apologize for bothering you, but, I could not find this answer anywhere on the Internet. Obviously this answer will make a big difference on how much Vitamin D supplements I need to take.
Answer: Yes and No. Each 1,000 feet in elevation equals about 1 degree closer to the equator (from where you are) so Denver, latitude 39.46° at altitude 5,280 ft would have a similar UV-B to a location at 33-34°, not all that UV-B rich. Reflective snow in winter would make mid-day more intense but as to available D it just isn't t all that much because UV-B is less in winter in all locations more distant from the equator. Only locations 30° or closer to the equator have consistently intense UV-B. Whether using sunlight or supplements the only way to know how much you need is to record how much you get and test 25(OH)D.
Supplemental D or sun exposure should not be based on location because your need for D depends on much more than that; your skin color, your age, your sunning habits, your diet, your genes, your weather (clouds, fog and some urban pollution, aka urban ozone, block UV-B). The only way to know how much D you have and how much D or sun you need and if the supplemental D or sun, or tanning bed you are using is working is TESTING. TEST and RETEST, don t guess. Your HMO, your physician, lef.org or ZRT Labs provide you a means of monitoring your D. Use your resources.
Question: Since we cannot really live half of the year in the tropics, we thought about using UV lamps, but it is hard to know which type can reliably deliver the correct amount of UVB rays. Have you investigated specific brands etc? Unfortunately, there is not much help to be had from local doctors, as they usually have a deep prejudice against UV lamps instilled by dermatologists.
Answer: Wolff tanning beds (beds that use Wolff lights) may be used to replete vitamin D. These beds are often referred to as "20 minute" beds. The amount of UV-B is similar to summer sun BUT the danger is in staying too long. You make all the D you will make BEFORE your skin alters in any way, even the very lightest of pink . Tanning actually reduces the amount of D you are able to produce on your skin. Light skinned persons would need 7-10 minutes, maybe less, to produce significant amounts of D. A responsible proprietor and NEVER staying longer than you need are keys to safe use of tanning beds. Further instructions on safe use of beds may be found in the Sunlight packet below. A note of caution- any exposure to UV light lowers the amount of vitamin A and vitamin C in your skin .If you decide to use light to produce vitamin D consider how much extra A and C you need to keep your skin happy and healthy.
Question: ...have read (looked at) several articles on this subject. They give good descriptions of the beneficial effects. But so far, I have not seen (Yes, I m sure it is there, somewhere!) a listing of times considered advantageous. And yes, there are many factors. For instance, time of year, condition of the sky etc but the one I'm interested in is time for an average person, at a reasonable latitude, like 35 °, and importantly the % coverage of the sunlight recipient! If a person is nude they require less time than if one is in normal clothing and a person dressed like an Eskimo might as well stay inside. Can you give any benchmarks for a person such as me. And yes, I have another disadvantage, I m 86 years old!
Answer: Some researchers suggest a particular amount of sunlight is equivalent to a particular dose of D. I have been testing 25(OH)D in several hundreds of clients since 2000 and found no correlation of either D intake or sun exposure and 25(OH)D that was useful long term as a rule or guideline for others.
Aging skin produces significantly less D even when UV-B is present and there is the issue of excess sun exposure, level of vitamin A present in skin, level of cellular anti-oxidants including vitamin C, and the incidence of skin cancer. Life requires we balance benefit and risk of all our behaviors.
At 38° north a very light skinned person might need 10-12 minutes per side, mostly naked, between 10AM and 2pM, to raise D to between 50-60 ng/ml. By December 25(OH)D may drop below 40 ng/ml. If the location was in a city (with city haze) vitamin D production might be much less.
Nude does not correlate with time at all. You make as much D as you will make just prior to erythema (pinkness or the equivalent) which might be 7 minutes in very light skin and as much as 120 minutes in very dark skin (which also may burn from excess exposure but you won t see it). Sunning longer will not produce more. You have just so many genetically pre-determined "vitamin D factories" per cm of skin, some parts of the body having more factories than other parts. More skin will produce more D but again, this is a genetically determined variable with wide variations in amount . In addition to amount of skin exposed UV-B intensity, skin color, skin age and your genes all alter outcome.
A client who took no D, lives on the East Coast and has little sun exposure, tested with moderately HIGH levels of 25(OH)D. For her supplementation or more sun exposure would be excessive. Sunning requires first that significant UV-B is present which at 35° would be (depending on altitude and city/country) perhaps April 15-Sept 15 between 10AM and 2pM. The closer to noon the higher the UV-B.
Repeated testing of whatever method you choose to use, sun or supplements or a mix of both, will show you if your choice is effective. If it is not, make a different choice.
Question: Whenever I try to take D I experience ... (allergic reaction, depression, digestive distress, weakness, sleepiness, muscle or nerve reaction, or other unpleasant reaction). How do I get/take D?
Answer: You may need someone to help you determine all your nutritional needs, not just vitamin D. Things work together in our bodies. We need protein, high potassium foods (fruits/vegetables), small amounts of vitamins and minerals and trace elements to make things work right . Just adding one or two things may make others work less well. We are complex living systems. Consider a consultation. Read the http://krispin.com website. As the clinical studies show, having high amounts of vitamin D without A may create a relative functional vitamin A deficiency as having high amounts of vitamin A may create a relative functional vitamin D deficiency.
The Sunlight packet containing the Preliminary Report with physician and patient protocols is the how , the instructions on using sunlight and vitamin D safely. The Preliminary Report is available now, containing an overview of vitamin D information/research, a patient protocol, a physician protocol, and testing guidelines for those who want the how to information. The physician and patient protocols are not included in the book. The Report and protocols detail how to safely maximize D using sunlight and/or supplement.
Supplement companies are selling vitamin D in doses from 400 IU to as much as 50,000 IU. Supplement companies periodically send newsletters continuing to report the benefits of vitamin D and harmful effects of having too little D. One might assume buying and taking one of these supplements will make sure you are sufficient in vitamin D. When I began researching vitamin D for my book (see below) I thought I would find a wonderful substance that prevented and perhaps even cured many diseases and that the subject would be simply, wow, it s great, make sure to get lots. That was in 1999. The manuscript (without an index) has been basically finished since 2002 (updated when appropriate) and I have been working with vitamin D and clients since 1999.
Regardless of how many new papers are published the facts remain the same. Every person absorbs and/or produces vitamin D in varying amounts. One person may simply expose arms and legs several times a week and have and maintain adequate levels of D, others may take a supplement of 4,000 IU daily and for various reasons not increase their 25(OH)D at all. And again, others may simply increase calcium intake and their 25(OH)D will rise with no supplemental D. I cover this in detail in the Sunlight packet/Preliminary Report and further discuss why this may happen in the book/manuscript.
I made the decision to provide these resources because people need to know. I literally print out the items at the time they are ordered because it allows me to make changes along the way as I find a better way to state what is true. It is not my truth. It is not conjecture or opinion. The facts presented are a distillation of ongoing considered study of the literature from the first discovery of vitamin D to the present day, and hands on experience working with people, sunlight and vitamin D over the past 9 years. As to money, let me state that the costs of my ongoing research and operating expenses are not now nor will ever be covered by any sales made from this site. As with my personal krispin.com site I consider this to be a part of my service.
Some people need more D, from sunlight and/or supplements. Some people don't. Some people need more than other people because of many and varied reasons. The information in the packet and the manuscript is as factual (with references) today as when they were written and if updating is needed it is (and has been) done.
My concern about excess D supplementation continues because the marker of excess D being used currently (high serum calcium or urinary calcium or both) is not the only validated marker/side-effect of excess D. Excess serum cholecalciferol (D3, what you make from sun or take in a supplement) and/or excess 25(OH)D may interfere with the actions of 1,25(OH)2D, the so-called active hormone D, without changing serum or urinary calcium. As 1,25(OH)2D has (so far) 50 known cellular targets (according to Walter Stumpf, PhD, personal communication) though only 30 are currently recognized, most of them not related to bone, making sure you get enough but not too much is important. ANY possible benefits of over-enthusiastic sunning or supplementing which increase 25(OH)D beyond 60 ng/ml are not supported by any research studies. Taking 5,000 IU or 10,000 IU daily for some period of time may give you the test results you want BUT continued use of that same dose may continue to raise your D beyond optimal limits. TEST, make sure you really are getting and using what you take, enough and not too much.
If you want the story order the manuscript which covers the history of D and sunlight and the what and why . If you need to know how to monitor and maintain optimal vitamin D safely, order the Report with protocols.
Cautions: The book, Naked at Noon, does not contain detailed instructions on how to maximize vitamin D safely. For all vitamin D enthusiasts- please do not take D in amounts larger than 2,000 IU daily from all sources without clinical testing, physician guidance, or cautious personal monitoring if a physician is unavailable. Read the excerpts from the book. If you believe you need more D please order the Preliminary Report to make sure you are using sunlight and D safely. Some may benefit from 2,000 IU or more daily BUT it is important to KNOW, not guess.
Harm can occur from excess D as well as insufficiency. Taking D when it is not needed is potentially dangerous no matter what form of D you may be taking. Do not self treat without regularly monitoring your levels of 25(OH)D and seek help if you aren't t sure how to do this..
Various websites and experts are currently enthusiastic about vitamin D and state high doses of vitamin D, doses ranging from 2,000-4,000 IU or more, are safe. A primary focus of my book is a review of research showing studies being cited as the basis for claiming high doses of vitamin D are necessary and safe were faulty when they were first published. High doses of D may be absolutely necessary for some but for others the same dose would be excessive in the short or long term.
The conclusions drawn by safe vitamin D proponents (including some of the researchers themselves) often overlook major flaws in the studies. To mention just one of the flaws, few studies have been done using high dose vitamin D for longer than 6 months. A recent study with children lasting a year found several of the participants with excess levels of vitamin D. D toxicity (like vitamin A toxicity) may take a year, two years, or longer to develop, putting the compliant patient/user at risk.
Another overlooked problem is the interaction between calcium and vitamin D. Taken together there is a strong synergistic effect and less amounts of both substances are needed. As testing is done without correction for calcium intake conclusions are again, problematic. High doses of D when calcium sources are low have a different outcome than when D and calcium are used in combination. The US diet is relatively high is calcium (depending of course on who, when, where) and for many (not all) calcium lowers the relative need for vitamin D.
I am positive about the wisdom of my caution because I have seen the outcomes, having begun working with high dose D in 1999. The book clearly describes the problems facing any policy of food supplementation or long term high dose D supplementation.
Recently a blog site criticized my caution and suggested I am trying to sell my book. FYI, after some ten years of exhaustive study and writing, I have spent much more on research for the book than I will EVER recoup when from book sales. I suggest the Report and/or book because the issue really is complicated and a few paragraphs, or a one-size-fits-all prescription , just won't do. I believe we need knowledge to care wisely for ourselves and our families.
I am enthusiastic about safe use of sunlight and vitamin D. Having enough D makes life better. I know from experience supplementing D is problematic.
Some supplement users absorb poorly, some combine supplements with sunlight for rapid excess, some use supplements that just don t seem to work. My personal preference is the safe use of sunlight to get D but I know that for many this may be impossible. It is a new world out there. We have moved from ancestral sources and have no way to recreate these sources in our new locations. Whether using sunlight or supplements, testing makes sure you are getting enough and not too much.
I would say from a review of the research and from personal and professional experience most benefit from extra D, especially D from sunlight, but we are all individuals and what is right for one may not be right for another.
Enthusiastic promoters of natural vitamin D or cod liver oil suggest that, as it is natural, it is safe in high amounts. Some use references to prove their claims. Clinical data strongly contradicts any belief that high doses of vitamin D, whatever the source, are safe. It is true, however, getting excess A and D combined, as is possible with excessive cod liver oil intake, is safer than excess D or excess A alone. Vitamin A is protective when excess D is present and D protects from excess A, BUT having the right amount, neither excess or insufficiency of either makes more sense.
This issue is exhaustively addressed in the book. There have been a number of cases reported to me of vitamin D excess with debilitating results, including tetany, depression, and/or significant bone loss. None of these persons experienced the clinical definition of hypervitaminosis D but these are unhealthy side-effects nonetheless. Monitor your D.
For the past number of years clinicians, physicians, national media, and the National Institute of Health have been warning Americans to stay out of the sun. The purpose of this warning is intended to prevent melanoma, a serious form of skin cancer. In spite of the ever-increasing use of sunscreens and intentional reduction of sun exposure, incidence of this cancer continues to rise. There is evidence that the advice to avoid sunlight may be contributing to the increased incidence of melanoma. One possible reason for this may be issues relating to genetics and extended exposure to UV-A light. When sunscreen is used sun burning is reduced or eliminated and the sunscreen user s time in the sun is extended. While UV-A is not as strong as UV-B it does cause damage over time and most sunscreens either do not block or poorly block UV-A no matter what the SPF may be. Whatever the cause, the expected reduction in skin cancer with sunscreen use has not occurred.
One of the known protectors of skin cells from pre-cancerous changes is vitamin D and your skin actually contains the enzyme that converts sunlight D into active 1,25(OH)2D, calcitriol. For most Americans the primary source of vitamin D is sunlight. UV-B, the only band of light producing vitamin D, is significantly present only midday from late spring to early fall in most of the U.S., the exact time we are advised to avoid sunlight. UV-B is blocked by sunscreen. We have an international disaster in progress due to a misunderstanding of the nature of and need for UV-B and vitamin D.
A blood test for 25(OH)D, 25-hydroxyvitamin D, is the only way to tell if you have or are taking the correct amount of vitamin D, need to take any D, or if your sun habits are sufficient. Too little vitamin D contributes to many degenerative diseases but excess vitamin D is equally undesirable. Because of the varied ethnicities, latitudes and lifestyles in the United States (and most of Europe and Asia too) the only way to safely use supplemental vitamin D is test, test and retest. Click on the Vitamin D Testing link for a relatively inexpensive way to monitor your D.
Low D needs to be corrected, carefully. Moderately high levels of 25(OH)D, greater than 70 ng/ml (175 nmol/l) have been associated with bone loss, heart disease, and other soft tissue calcification. When chronic intake of excessive amounts of vitamin D raise serum 25(OH)D further, irreversible damage may occur. The optimal range of vitamin D is 40-60 ng/ml (100-150 nmol/l).
In locations greater than 30° latitude, north or south, values are naturally higher at the end of summer and early fall and lower in winter and spring. There is no evidence values higher than 60 ng/ml provide any added benefit.
TESTING: Reasonably priced testing is available for anyone in the US from the Life Extension Foundation. ZRT Labs is more expensive but may be an alternative choice for some and as the test is done at home from a small blood drop may be preferable for infants and children. Unfortunately the ZRT test is not available in California or New York.
Click on the little suns to reach the test ordering pages (let me know if any links are broken).
At LEF.org the test is $47 for LEF members and $63 for non-members. Test results are provided directly to you through the Foundation. Testing sites are easily accessible in most states. I am not a member nor in any way affiliated with Life Extension, nor do I necessarily their products. I do support reasonably priced testing of vitamin D.
Private MD Labs, provides local testing of 25(OH)D (Vitamin D-25 hydroxy) for just $59.99 and first time customers get a 15% discount (see link on their home page). They also offer many other tests at reasonable prices. Results are sent directly to you. Vitamin A, Serum is a good test to get if using cod liver oil to make sure your vitamin A is not excessive but it will NOT tell you if you have enough vitamin A.
Healthcheck USA is a great resource for self ordered blood testing. Vitamin D is $70 but you might find it convenient to combine with other tests you need. Compare prices between this, private MD Labs and LEF.ORG.
Home Health Blood Test provides a do-it-yourself at home blood spot kit. It is good for those that want to take control of their own testing or excellent if you need to test infants or children (no needles). The price is $60 for a blood spot kit that is accurate and requires just a few drops of blood. Unfortunately this test is state limited. Make sure you live in a state that allows self testing (not New York or California)
Do not supplement in amounts greater than 1,200 IU (total from all sources daily) unless you are being tested and treated by a healthcare professional who understands clearly both the benefits and dangers of vitamin D. If a professional is not available, do monitor yourself. Minimum testing, if using supplements, should be not less than every four months the first two years and every six months the third and fourth years. Excess intake of vitamin D may not show up as elevated 25(OH)D until as long as 2-3 years after starting a dose that was seemingly safe initially.
Less testing is needed if you use sunlight to raise your D. Typically end of summer and end of winter will give you a good idea of the success or failure of using sunlight as your primary source. Sunlight is a safe source for most persons in the US with the exception of light skinned persons living in Hawaii, Florida or other locations with elevated levels of UV-B. All skin types regularly exposed to UV light will have a higher need for dietary vitamins A and C which protect the skin..
If you have light skin and live in an area with high UV-B, sunning should be very limited. Combining sunlight and supplements may rapidly overload the D endocrine system in summer months.If you regularly sun in summer and have skin types 1-3 it is unlikely any supplementation is needed during all or most of the year. For darker skins the only US location likely to provide adequate sunlight is Hawaii (this is yet to be determined) and supplements may be a requirement for long term health. As response to supplementation is difficult to gauge, testing should be mandatory. Most HMOs will recognize the benefits of supporting optimal 25(OH)D. The Preliminary Report explains how to determine your need and how to use supplements and sunlight safely. A physician protocol is included with the Report to share with your doctor.
Vitamin D, the kind you make
on your skin, get in fortified milk, or take in a vitamin supplement, is
not a vitamin. It is more appropriately classified as a pro-hormone. Not
only is it a pro-hormone it is a sunlight derived pro-hormone. The active
hormone D, calcitriol, controls calcium in vertebrates and invertebrates.
Calcium controls innumerable processes in the human body including specific
responses in muscles, bones and glands. Calcitriol is a major player in
genomic actions determining how our cells express themselves and regulating
production of numerous substances including enzymes, hormones and neurotransmitters
We all need sunlight and/or vitamin D. Clinical studies demonstrate our ability to produce/absorb/utilize sunlight and vitamin D is genetically variable. At the present time many persons world-wide suffer from D deficiency or insufficiency. Testing is the only way to know how much D you have and testing is the only way to monitor D supplementation. As actions of a pro-hormone are essential to health and life, guessing or assuming is not a wise way to determine optimal levels.
In northern California 80% of clients tested during winter months have serum vitamin D deficiency (less than 20 ng/ml) or insufficiency (20-32 ng/ml). This problem increases dramatically in persons living at latitudes more distant from the equator and in persons living in all US latitudes with darker skins. In Texas there has been an increase in the number of children with African or Hispanic heritage suffering from rickets. Even in sunny southern California vitamin D deficiency or insufficiency is prevalent in part due to avoidance of midday sunlight and/or the use of sunscreens which block vitamin D production .
Getting enough vitamin D, from sunlight or supplements, is important to health and longevity but too much supplemental D or sunlight can be disease producing. Too much, too little- the only way to know how much D you have and how much sunlight or D you need to maintain D sufficiency is to test.
To find out more about me please visit krispin.com and take a look around. This is my personal web site designed to provide basic information about me and about nutrition in the 21st century. View my article, The Miracle of Vitamin D, published in Wise Traditions for an overview of the D report. The Miracle of Vitamin D was written at the beginning of my search for the truth about sunlight and vitamin D. This article should not be used as a basis to diagnose or treat sunlight or D insufficiency. Much of its information is now old and out of date. Cod liver oil is not always the best way to get vitamin D. The article does not have any of the guidelines, protocols or other information provided in the book, the Preliminary Report or in The Professional's Guide. Wise Traditions is published by the Weston A. price Foundation , a strong supporter of whole, natural, traditional foods, and healthy life styles.
NEED HELP NOW? I accept private clients internationally and work by phone, fax, mail and email. If you need personal help with any health issue, including support when undergoing traditional medical treatments, download the information and forms packet as an Adobe fillable forms file. You ll need the free Adobe Reader™ to fill in the forms. To fill, just click on typewriter at the top in Adobe Reader 9, place your cursor and begin typing. Use X to mark optional choices. Do print a copy for your records. You may email, print and send, or print and fax the finished forms.
If you prefer, call my home office, and leave your name, address, zip and phone number. Speak slowly and clearly, spell any words likely to be mistaken on a message machine. I will e-mail (preferred and fast), fax, or mail you an information packet, no obligation, containing forms and a clear explanation of what I offer and what it costs. As stated I work by phone, fax, mail and email. I do not see clients in person. I do not sell ANY products. I offer personal support and intensive education, to enable you to care for yourself (and for your family).If you email or call with personal health information and questions and are not a client I will not be able to respond due to time constraints and other complicating legal and medical issues. Please request the Information packet which contains the information and forms needed to decide if you would like to consult with me to begin the process. The packet explains what I do and contains the forms needed to begin your consult. There is no obligation when requesting this information. Download here.
Physicians with questions about vitamin D should first order the Preliminary Report which contains a referenced physician's protocol and other materials. If questions remain after reviewing the report call me. 1-775-831-0292 physicians calling to discuss vitamin D issues re patients are welcomed. Have your questions prepared with detailed information on patient history. You may fax or email information and questions prior to your phone consult. You will be billed/invoiced for actual time used.sunlightd.org Krispin Sullivan, CN Voice 1-775-831-0292 (callers will be charged for consultation) Fax: 1-775-525-0292 Follow link to email me and/or subscribe to my FREE newsletter Krispin's (Sporadic) Komments on Nutrition and Health. See last year's newsletter here. The latest issue is here.
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