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Dr. Gregory Pais, ND
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Home arrow Naturopathic News arrow Issue #139&140 April/May 2014
Issue #139&140 April/May 2014
Welcome to this combined issue of Naturopathic News, issue #139 & 140 (April/May 2014). It's my mission to help you find optimal solutions to health problems. This newsletter is one way to do that. The more educated you are about your health options the better able you will be to take control of your health. If you would like to stop receiving my newsletter please send me an email and let me know. If you have a friend or family member who you think would appreciate the information provided, send me their email address. 

2014 Class Series
So far, everyone has indicated that they are interested in taking more classes. I'm working on the next class schedule and am inviting your input for when you would like me to teach. 

The plan is to have a one day class on Lyme Disease this Summer or no later than September. Please make your voice heard, send me an email, and let me know whether you prefer July/August or September.

Many of you really appreciated last November's comprehensive newsletter issue on homeopathic medicine. This month I thought it would be useful for you to have this issue. It's a collection of my Vitamin D writings (blog and newsletter). Enjoy!

#1. Vitamin D is actually a hormone metabolized from cholesterol under the influence of sun exposure. It has direct effects on the following cells: cancer, bone, breast, prostate, ovary, uterus, liver, lung, muscle, intestine, kidney, brain, fat, adrenal, cartilage, nerve, hair follicle, intestine, parathyroid, parotid, pituitary, placenta, skin, stomach, testis, thymus, and thyroid.

#2. Even people outside in sunny climates like Arizona and Hawaii don't get enough Vitamin D from sunshine. Throughout history we spent most of the day in the sun, hunting, fishing, gathering, and farming. We physiologically developed to need that much vitamin D. The sedentary indoor lifestyle of modern day people gets much less. Add to that the huge error in telling everyone to stay out of the sun and you end up with suboptimal levels.

#3. Vitamin D is mostly stored in fat tissue and is converted to 25(OH) D3, which is the best laboratory analysis of vitamin D levels in the body. 1,25(OH)D3, the most common test that labs and doctors run is the wrong test. It is not a useful measurement for disease treatment or prevention.

#4. The "normal" laboratory reference range for Vitamin D tests is not useful for disease prevention. Any value below 40 ng/dL shows a functional Vitamin D deficiency. Optimum levels are 50-80 mg/dL depending on an individual's state of health.

#5. The US government RDA for Vitamin D-400 IU-is a joke. It's flat out wrong. 
Dr. John Cannell, one of the most knowledgeable physicians involved in Vitamin D research, recommends the following amounts:
Well children under the age of two should take 1,000 IU per day, over the age of two, 2,000 IU per day. Well adults and adolescents between 80 pounds and 130 pounds should start with 3,000 IU per day, over 130 pounds but less than 170 pounds, 4,000 IU per day and over 170 pounds, 5,000 IU per day. 

Two months later have your physician order your first 25-hydroxy-vitamin D blood test. Then adjust your dose so your 25(OH)D level is between 50 and 80 ng/ml, summer and winter. These are conservative dosage recommendations. Most people who avoid the sun - and virtually all dark-skinned people - will have to increase their dose once they find their blood level is still low, even after two months of the above dosage, especially in the winter.

#6. You can cause yourself harm by taking Vitamin D on your own. It's critical that you work with a practitioner who has professional training and experience. The main concern of excess Vitamin D supplementation is hypercalcemia, that's why periodic blood tests are so important. 

#7. The only form of Vitamin D that you should take is vitamin D3, or cholecalciferol. Vitamin D2, or ergocalciferol is less active and not as easily absorbed. D2 was the most common form used to 'fortify' foods like milk. It's also the most common form used by MDs-usually in high amounts, 50,000 IU at a time.

#8. Osteoporosis and rickets (childhood softening of bones) are two of the most well known diseases treated by Vitamin D. Some of the diseases treatable/preventable by optimum Vitamin D levels are breast, prostate, and colon cancer, heart disease, multiple sclerosis, and depression.

Anthony Norman, an international expert on Vitamin D, is a researcher at the University of California Riverside. In a paper published in the August 2008 issue of the American Journal of Clinical Nutrition, Norman identifies vitamin D's potential for contributions to good health in the immune system, the secretion and regulation of insulin by the pancreas, heart and blood pressure regulation, muscle strength and brain activity. In addition, access to adequate amounts of vitamin D is believed to be beneficial towards reducing the risk of cancer. This makes Vitamin D, once thought only to affect bone diseases such as rickets and osteoporosis, a major player in contributing to overall human health,

Norman also lists 36 organ tissues in the body whose cells respond biologically to vitamin D. The list includes breast, colon, intestine, prostate, uterus, retina, skin, stomach, kidney, lung, and bone marrow.

According to Norman, deficiency of vitamin D can impact all 36 organs. Vitamin D deficiency is already, is associated with muscle strength decrease, high risk for falls, and increased risk for colorectal, prostate and breast and other major cancers.

"It is becoming increasingly clear to researchers in the field that vitamin D is strongly linked to several diseases," said Norman, a distinguished professor emeritus of biochemistry and of biomedical sciences who has worked on vitamin D for more than 45 years. "Its biological sphere of influence is much broader than we originally thought. The nutritional guidelines for vitamin D intake must be carefully reevaluated to determine the adequate intake, balancing sunlight exposure with dietary intake, to achieve good health by involving all 36 target organs."

Vitamin D is manufactured in the body in a series of steps. First, sunlight's ultraviolet rays act on a starter compound in skin. When skin is exposed to sunlight, a sterol present in skin tissue is converted to vitamin D, which, in turn, is metabolized in the liver and kidneys to form a hormone. It was Norman's laboratory that discovered, in 1967, that vitamin D is converted into a steroid hormone by the body.

"To optimize good health you must have enough vitamin D," he said. "Vitamin D deficiency is also especially of concern in third world countries that have poor nutritional practices and religious customs that require the body to be covered from head to toe. Ideally, to achieve the widest frequency of good health by population, we need to have 90% of the people with adequate amounts of vitamin D."

"There needs to be a sea change by various governmental agencies in terms of the advice they present to citizens about how much vitamin D should be taken," Norman said. "The tendencies of people to live in cities where tall buildings block adequate sunlight from reaching the ground, to spend most of their time indoors, to use synthetic sunscreens that block ultraviolet rays, and to live in geographical regions of the world that do not receive adequate sunlight all contribute to the inability of the skin to biosynthesize sufficient amounts of vitamin D." About half of the elderly in North America and two-thirds of the rest of the world are not getting enough vitamin D to maintain healthy bone density, lower their risks for fracture and improve tooth attachment.

"More than ever we need to increase the amount of research on vitamin D, with more funding from government agencies and pharmaceutical companies, to meet the challenge of preserving or improving the health of everyone on the planet," Norman said.

While vitamin D deficiency has major negative effects, taking high doses of vitamin D can cause hypercalcemia, a condition in which the blood's calcium level is above normal.

Research in the June 2007 Journal of Clinical Endocrinology & Metabolism appears to indicate that vitamin D levels can be low for many people, even when they have a lot of exposure to sunlight. This goes against the prevailing thought that not enough sun exposure is the reason why so many have low vitamin D levels. This theory has been supported by the correlation of low vitamin D levels with the medical recommendation that people stay out of the sun.

Dr. Neil Binkley and colleagues, working in the University of Wisconsin Osteoporosis Clinical Research Program, investigated the vitamin D status of people living in sun-drenched Hawaii. The 93 participants in the study spent an average 22.4 hours per week outside without sunscreen and 28.9 hours per week outside with and without sunscreen. The authors calculated that this translated to an average of 11.1 hours per week of total body skin exposure with no sunscreen used. Despite this abundant sun exposure, 51 percent of these individuals were found to have low vitamin D levels, the researchers found.

"This implies that the common clinical recommendation to allow sun exposure to the hands and face for 15 minutes may not ensure vitamin D sufficiency," Binkley and colleagues report. Their conclusion was that it should not be assumed that individuals with abundant sun exposure have adequate vitamin D status.

The mechanism by which vitamin D levels could be low, even with more than adequate sunlight exposure was not proposed in this study. However, there are some known issues. Prednisone other steroids can interfere with vitamin D. The same is true for Dilantin, a drug used for seizures. Sufficient bile production is necessary for the absorption of vitamin D from the small intestine so those with liver/gallbladder disease, or those who takes drugs that affect these organs-like the millions who take drugs for cholesterol-may have difficulty producing enough vitamin D.

The Canadian Pediatric Society is recommending that pregnant or breast feeding women consider increasing their vitamin D intake to 2,000 international units (IU) a day. This increase is designed to reduce the chances that their children will develop such ailments as cancer, diabetes, and multiple sclerosis later in life.

For the second time in 2007 a major Canadian public health advocacy group has decided the evidence for taking vitamin D has become so compelling that it is making new recommendations. In June of this year, the Canadian Cancer Society said adults should take 1,000 IU a day. At the same time a U.S. study found that taking vitamin D at levels above those deemed adequate by Health Canada reduced cancer risk by 60%.

During 2007 there has been a growing body of evidence that increased exposure to vitamin D in fetal and infant development may offer protection against cancer, asthma, osteoporosis, inflammatory bowel disease, and dental cavities. "New findings suggest that adequate vitamin D status in mothers during pregnancy and in their infants may have lifetime implications," the recommendation said.
DR. PAIS'S COMMENTS: This is a striking nutritional recommendation by a conventional medical organization. For such a group to suggest 2,000 IU Vitamin D3 (cholecalciferol) per day, you know the evidence must be compelling.

It would be very difficult to get this much Vitamin D each day simply by food. And many supplements provide the inefficient form of Vitamin D-D2 or ergocalciferol. It's a good idea to get the correct vitamin D test done before you supplement so you know how much you need and can track how long it takes to reach optimum levels.

In 1991-92 researchers at the University of Southampton tested Vitamin D levels in hundreds of pregnant women. Then, almost 10 years later, they examined the bone health of their children. The study's results, published in the January 2006 issue of The Lancet, indicate that those children whose mothers were deficient in Vitamin D during pregnancy may grow up with lower than normal bone mass. This would put them at risk for osteoporosis-related bone fractures later in life.

Basically, the children of moms with low Vitamin D status had lower bone mass than the ones that came from moms with normal Vitamin D status. This difference in bone mass would be enough to increase your fracture risk from 30-50% if your mother was Vitamin D deficient during pregnancy.

During pregnancy Vitamin D helps transport calcium from the mother through the umbilical cord to the fetus. There it is used to help form the baby's bones. Whether you are an adult or a child Vitamin D is critical for the absorption of calcium from the gut. This helps create strong teeth and bones, and greatly affects the whole muscular skeletal system.

For the test, vitamin D levels were taken from the blood of 596 women during the third trimester of pregnancy. Then the calcium level was assessed in blood drawn from their babies' umbilical cords at birth. Nine years later, the researchers performed bone density tests on almost 200 of the children. If the mom had a low Vitamin D level in pregnancy then there was an increased chance of lower calcium levels in the cord blood. Which correlated with lower bone mass when the child was tested at nine years old.
DR. PAIS'S COMMENTS: If you're not getting Vitamin D from sunshine then the only other way to get it is through food or supplements. 

Only a few common foods are good vitamin D sources: International Units (IU) per serving
Cod liver oil, 1 tablespoon 1,360
Salmon, cooked, 3½ ounces 360
Mackerel, cooked, 3½ ounces 345
Tuna fish, canned in oil, 3 ounces 200
Sardines, canned in oil, drained, 1¾ ounces 250
Egg, 1 whole (vitamin D is found in egg yolk) 20
Liver, beef, cooked, 3½ ounces 15

The problem with most fish is that it is highly toxic from ocean pollution. The Vitamin D that is used to 'fortify' dairy products, D2, is 1/30th to 1/40th as useful as D3, which is what is found naturally in food. If you totally avoid the sun, estimates are that you need  a minimum of 4,000 international units per day to maintain health. So it's very difficult to safely obtain your Vitamin D from foods. Individual need should be judged on a case-by-case basis, based on testing, and supplemented accordingly. 

This study, published in Circulation, looked at the vitamin D status of 1,739 Caucasian adults who were free of heart disease at the beginning of the study. They were monitored for different cardiovascular events- angina, stroke, heart attack, coronary insufficiency (chest pain caused by low blood flow to the heart muscle), transient ischemic attack (TIA), leg pain when walking, due to poor circulation, and heart failure-over an average of about seven and a half years. 

People with low vitamin D levels were 2x as likely to have a cardiovascular event as people with normal levels, and the risk was highest in people with high blood pressure plus low vitamin D levels. It's no surprise that vitamin D is important in heart health as Vit. D receptors exist in blood vessel walls and in the heart muscle itself.

Though Vitamin D deficiency in childhood, known as rickets, is more commonly known, its presentation in adults is not so obvious. Yet every patient that I've asked to test for Vitamin D has had suboptimal levels. Evidence is growing that up to 50% or more of the population may be low. This increase in adult deficiency is most likely due to the medical recommendation to stay out of the sun or use sunscreen. We're beginning to reap the consequences of this action in the increase in Vitamin D-related diseases.
Circulation 2008;117:online publication

This 17-year follow-up of roughly 4,000 men and women, found that individuals with higher blood levels of vitamin D had a 40 percent lower risk of developing type 2 diabetes than those with lower levels of this vitamin. This level of protection goes way beyond any current drug protection.

187 people developed type 2 diabetes during follow-up. After adjusting for gender, age, and month when blood samples were obtained, a statistically significant inverse association was observed between the blood vitamin D level and the development of type 2 diabetes. Those with the highest vitamin D levels had a 40% lower risk of developing type 2 diabetes as those with the lowest vitamin D levels. 
Diabetes Care, October 2007
DR. PAIS'S COMMENTS: The benefits of optimum vitamin D levels seem to go on and on. Now we can add diabetes protection to the list. At the cost of only a few cents each day a disease that costs billions of dollars to treat each year could be prevented. When safe, low-cost preventive strategies like this are not suggested by your medical practitioner is it any wonder the cost of health care in this country is astronomical?

According to this review taking vitamin D supplements in infancy may help a child prevent Type 1 diabetes. British doctors looked at five studies in which children were monitored from infancy to early childhood to see if vitamin D supplements made a difference to the risk of becoming diabetic. The risk of developing the disease was reduced 29% in children who took extra vitamin D as compared to those who had not.

Diabetes is a chronic disease in which the body does not produce enough of the hormone insulin, or cannot make proper use of the insulin it does produce, a condition called insulin resistance. Insulin is one of the major hormones responsible for regulating blood sugar. In Type 1 diabetes beta cells in the pancreas that produce insulin are destroyed in early childhood by the body's immune system. It is most common among people of European descent, affecting around 2million Europeans and North Americans. This research indicates that lack of Vitamin D may be one reason why Type 1 diabetes has become more prevalent in recent years.

Type 2 diabetes, which is far more common, is linked to consumption of fast food, 'diet' products, obesity, and a lack of exercise. It is reaching epidemic levels in countries like the United States where processed foods are consumed, vegetables and fruits are ignored, and exercise is lacking.

Analysis of data from these studies showed that the risk of type 1 diabetes was significantly reduced in infants who were supplemented with vitamin D compared to those who were not supplemented. There was also some evidence of a dose-response effect-those using higher amounts of vitamin D were at a lower risk of developing type 1 diabetes.
March 13 2008 Archives of Disease in Childhood

According to this study, more than half of American women receiving drug therapy for osteoporosis are deficient in vitamin D. Vitamin D is necessary for calcium absorption and metabolism and is required for healthy bones and to protect against osteoporosis. This new research suggests that many women with osteoporosis are using drugs to treat a problem that should be addressed nutritionally.

The researchers measured blood levels of vitamin D and parathyroid hormone (which regulates calcium metabolism) in 1,526 postmenopausal women whose average age was 71. The authors used 30 nanograms/milliliter (ng/ml) as a cutoff point below which women were considered deficient. Just over half the women studied were vitamin D-deficient. Remember, nonwhite women have been shown to have even higher rates of Vitamin D deficiency.

According to the National Institutes of Health, 10 million Americans have osteoporosis and an additional 34 million have low bone mass, putting them at increased risk for the disease. In the United States, half of all women over 50 (and a quarter of all men that age) will have an osteoporosis-related fracture in their lifetime. Osteoporosis is very much a preventable disease considering that nutrition and exercise play such an important part.
Journal of Clinical Endocrinology and Metabolism 2005;90:3215-24
DR. PAIS'S COMMENTS: It's great to see this research study done. Any woman diagnosed with osteoporosis should have a serum hydroxy Vitamin D {also written 25(OH)D} test done. This is the correct test. The one to specifically ask for. Do not get the dihydroxy Vitamin D test. This is the incorrect test. Depending on your blood levels a supplement may be necessary. Make sure that you take cholecalciferol, which is Vit. D3. As Vitamin D is a fat-soluble vitamin it is retained in the body and can produce toxicity if too much is taken over time. I highly recommend that you discuss this with your friendly neighborhood naturopath before you start taking it on your own.

Calcium has been the focus of nutritional research for the prevention of postmenopausal osteoporosis as many clinical trials of calcium supplementation have found that it can indeed reduce bone loss and lower the risk of bone fractures.

However, the trials often include a simultaneous treatment with vitamin D, which makes it difficult to attribute the benefits to calcium alone. Also, the bone density increase found during the first year or two of calcium supplementation may not substantially increase in the long term.

In contrast to most clinical data, most observational studies did not find a significant association between calcium intake and fracture risk or bone loss. Despite this, and based largely on the clinical evidence, the Food and Nutrition Board of the National Academy of Sciences raised the recommended daily dose of calcium for women over 50 years of age to 1200 mg.

Commercial cow milk (formerly 'fortified' with the wrong form of Vitamin D) is often thought to decrease osteoporotic bone loss and fracture risk. However, there has been no clear benefit documented for women over the age of 50 years. It is known that calcium, at low or moderate doses, is largely dependent on the action of 1,25-dihydroxyvitamin D for active transport. Sufficient amounts of vitamin D are important in the prevention of postmenopausal bone loss.

For instance, one 18-year study, which examined calcium and vitamin D intakes, milk consumption, and use of calcium supplements among postmenopausal women, found that those with higher vitamin D intakes, either from food alone or from food plus supplements, had a significantly lower risk of hip fracture. However, calcium intake did not appear to be associated with fracture risk.

Insufficient vitamin D leads to less calcium absorption, elevated blood concentrations of parathyroid hormone, and increased rates of bone resorption, which may eventually lead to bone fracture. In line with this are several studies that have found that older people who experience a hip fracture have lower serum concentrations of 25-hydroxyvitamin D than do those without a fracture.

Some 25 percent to 50 percent of the elderly have vitamin D deficiency, which can lead to loss of muscle strength and an increased likelihood of falling that, in turn, increases the risk of hip fracture.

Sunlight exposure can be a major source of vitamin D. However older adults may not spend enough time in the sun to get adequate amounts of vitamin D. Also, sunscreens significantly reduce skin production of vitamin D. Another problem with obtaining vitamin D from sunlight is that synthesis of vitamin D is absent during the winter months in higher latitudes where nearly all of the United States is located.

As we age, vitamin D status may be further affected by a decreased capacity of the skin to manufacture vitamin D, a reduced ability of the liver or kidney to hydroxylate vitamin D to its metabolically active form, or a lower consumption of dairy foods or diminished intestinal absorption of vitamin D.
American Journal Clinical Nutrition February 2003;77:495-503
DR. PAIS'S COMMENTS: Over the last several years as I have practiced in this part of the country I have become more aware of the role that Vitamin D, Vitamin K (from green leafy vegetables), magnesium, boron, essential fatty acids, exercise, etc., play in bone health. It's important to not get locked into a single focus for a multi-factorial issue. As always, each individual's state of health must be considered-some people already have too much Vitamin D.

No, this isn't some thousand dollar a month chemotherapy drug or new surgical procedure. Hundreds of thousands of cases of cancer can be prevented for literally pennies a day. This new study looked at the relationship between serum levels of vitamin D and the risk of colon and breast cancer around the world and has estimated that 600,000 cases of breast and colon cancer could be prevented each year if vitamin D3 levels met the target proposed by researchers.

Cedric F. Garland, a cancer prevention specialist at the Moores Cancer Center at the University of California, San Diego (UCSD), estimates that 250,000 cases of colorectal cancer and 350,000 cases of breast cancer could be prevented worldwide by increasing intake of vitamin D3, particularly in countries north of the equator. Vitamin D3 is available through diet, supplements and exposure of the skin to sunlight.

"For the first time, we are saying that 600,000 cases of breast and colorectal cancer could be prevented each year worldwide, including nearly 150,000 in the United States alone," said study co-author Garland. The paper, which looks at the dose-response relationship between vitamin D and cancer, will be published in the August 2007 edition of the journal Nutrition Reviews.

The study combined data from surveys of serum vitamin D levels during winter from 15 countries. The data revealed an inverse association of serum vitamin D with risk of colorectal and breast cancer. The protective effect began at levels ranging from 24 to 32 nanograms per milliliter of 25-hydroxyvitamin D concentration in the serum. The 25-hydroxyvitamin D level is the main indicator of vitamin D status. The late winter average 25-hydroxyvitamin D in the US is about 15-18 ng/ml. The researchers maintain that increasing vitamin D levels in populations, particularly those in northern climates, has the potential to both prevent and possibly serve as an adjunct to existing treatments for cancer.

Previously studies by Garland and colleagues (Journal of Steroid Biochemistry and Molecular, February 2007) found that raising the serum 25(OH)D levels to 55 ng/mL was optimal for cancer prevention. This is the first study to recommend optimal vitamin D serum levels which, Garland said, are high enough to provide the needed benefit but which have been found by other scientists to be low enough to avoid health risks.

"This could be best achieved with a combination of diet, supplements and short intervals - 10 or 15 minutes a day - in the sun," said Garland. It could be less for very fair-skinned individuals. He went on to say "the appropriate dose of vitamin D in order to reach this level, could be very little in a lifeguard in Southern California... or quite a lot for someone in Northern Europe who tends to remain indoors most of the year."
The serum level recommended by the study would correspond to intake of 2000 International Units per day of vitamin D3 for a meaningful reduction in colorectal cancer. The researchers recommend 2000 IU/day, plus, when weather allows, a few minutes in the sun with at least 40% of the skin exposed, for a meaningful reduction in breast cancer incidence, unless the individual has a history of skin cancer or a photosensitivity disease. 

Other studies have shown an association between higher levels of vitamin D3 or markers of vitamin D status and lower risk of cancers of the breast, colon, ovary, prostate and kidney. The researchers call for prompt public health action to increase intake of vitamin D3 as an inexpensive tool for prevention of diseases that claim nearly one million lives each year worldwide.

Vitamin D may extend the lives of people with colon and rectal cancer, according to a study published on June 18. Previous research has indicated that people with higher levels of vitamin D may be less likely to develop colon and rectal cancer, also called colorectal cancer.

This study, led by Dr. Kimmie Ng of Dana-Farber Cancer Institute in Boston involved 304 men and women diagnosed with colorectal cancer from 1991 to 2002, to see if higher levels of vitamin D in the patients affected their survival chances. In fact, that turned out to be the case. Blood samples were used to determine vitamin D levels of the patients, and they were tracked for an average of about 6-1/2 years. Those in the highest 25% of vitamin D levels were about 50% less likely to die during the study from their cancer or any other cause compared to the patients in the lowest 25% of vitamin D levels. During the study, 123 of the patients died, 96 of them from colorectal cancer.

"It's probably premature to say that we should be recommending this as treatment for colon cancer, but vitamin D should definitely be studied in the setting of a clinical trial to see if it has any benefit to treating colorectal cancer," Ng said in a telephone interview. However, combined with a recent study by the National Cancer Institute that showed a 72% decreased risk of dying from colon cancer when Vit. D levels were higher, it makes compelling sense to have a Vit. D test done and supplement if necessary. This is especially true if you have a family history of colon cancer.

A number of recent studies have indicated vitamin D also may offer a variety of other health benefits, including protecting against types of cancer such as breast cancer, prostate cancer, peripheral artery disease and tuberculosis.
Journal of Clinical Oncology June 18, 2008

According to a new study published in the Journal of the National Cancer Institute, people with higher levels of vitamin D in their bodies are 72% less likely to die from colorectal cancer. Each year 50,000 people die from colon cancer in the United States.

Researchers tracked the health status of 16,818 people in a nationwide health survey. Participants joined between the years of 1988 and 1994 and were followed until the year 2000. Their blood was measured regularly to determine their bodies' levels of vitamin D. Those with higher levels of vitamin D at the beginning of the study were 72% less likely to die from colorectal cancer than those who began the study with the lowest levels of the vitamin.

The body produces Vitamin D when ultraviolet radiation from the sun strikes the skin. This means that deficiency can be a serious health problem in northern latitudes, particularly during the winter. However, recent studies are showing Vit. D deficiency even in residents in the sunny environments of Hawaii and Arizona. 

Deficiency in vitamin D can lead to rickets, a condition characterized by soft, weak bones, particularly in children. Optimal Vitamin D levels have been shown to be protective against skin, breast, prostate, and colon cancer, as well as osteoporosis, depression, multiple sclerosis, rheumatoid arthritis, and other diseases.

It's best to get the correct Vitamin D test done before you begin supplementation. Nausea, vomiting, feeling of sickness, and joint pain are all signs of too much Vitamin D.

If you are diagnosed with beast cancer, and happen to be deficient in Vitamin D at that time, you are almost 75% more likely to die from the disease then women with sufficient Vitamin D levels. Your cancer is also twice as likely to spreads to other parts of your body. From these results it seems that your Vitamin D status is linked to the progression of breast cancer.

Between 1989 and 1995, researchers tested the blood of 512 women who had been newly diagnosed with breast cancer. All the breast cancer cases were localized, meaning the disease had not spread beyond the breast and armpit region. The average age of affected women was 50.

15% of the women with healthy vitamin D levels died from their cancer, and 17% had their cancers spread to other areas. In contrast, 26% of the vitamin D-deficient women died, and 31% had cancer that metastasized. All together this means a 73% higher risk of death among women who were vitamin D deficient, and a 94% higher risk of the cancer spreading.

Vitamin D deficiency was a lot more common in women who weighed more. According to study author Pamela Goodwin of Mount Sinai Hospital and the University of Toronto, this is because "fat tissue acts as a trap for vitamin D." "Levels were also lower in younger women," she said, "which was a bit of a surprise, until we realized older women were taking more supplements." Premenopausal women and women with high insulin levels were also more likely to be deficient in vitamin D.

Only 24% of the women involved in the study had vitamin D levels considered healthy, while 37.5% were considered deficient and the remaining 38.5% fell in between. "This study found that vitamin D deficiency is very common among women with breast cancer, and it suggests that vitamin D deficiency is linked to poorer outcomes in these women," said Nancy Davidson, director of the breast cancer program at the Johns Hopkins Kimmel Cancer Center and president of the American Society of Clinical Oncology.
DR. PAIS'S COMMENTS: If you've been diagnosed with breast cancer get a serum hydroxy vitamin D test. You want your levels to be optimum-from 50-70 ng/ml. This is one fairly easy, safe, and reasonable action to take to improve your prognosis.

This is strong evidence that vitamin D can help prevent and fight off various cancers. We know that breast cancer cells have vitamin D receptors and interact with vitamin D. Part of this interaction is to cause cell death. This effect is very similar to the action of the drug Tamoxifen, but without the side effects.

If you are a breast cancer patient with a low level of vitamin D you are much more likely to die of the disease or have it spread than someone who has optimal levels of this nutrient.  

The skin makes vitamin D from ultraviolet light. Many believe that the extreme caution to stay out of the sun over the last 20 years is contributing to many health problems due to lack of Vitamin D. While the vitamin is found in certain foods and supplements, most don't contain the best form, vitamin D-3 or cholecalciferol, and have only a modest effect on blood levels of the nutrient. Vitamin D is in salmon and other oily fish, and milk is routinely fortified with it (often the less useful D-2), but dietary sources account for little of the amount of D circulating in the blood, experts say.

Only 24% of women in this Canadian study had sufficient blood levels of D at the time they were first diagnosed with breast cancer. Those who were deficient were nearly twice as likely to have their cancer recur or spread over the next 10 years, and 73% more likely to die of the disease.

"These are pretty big differences," said lead researcher Dr. Pamela Goodwin of Mount Sinai Hospital in Toronto. "It's the first time that vitamin D has been linked to breast cancer progression."

Lots of earlier research suggests vitamin D may help prevent breast, prostate, and especially colon cancer. In lab and animal tests, vitamin D stifles abnormal cell growth, curbs formation of blood vessels that feed tumors and has many other anti-cancer effects.
The Canadian researchers wanted to see whether it made a difference in survival. They took blood from 512 women at three University of Toronto hospitals between 1989 and 1995, when the women were first diagnosed with early-stage breast cancer.

10 years later, 83% of those who had had adequate vitamin D blood levels were alive without extensive spread of their cancer, versus 79% of those whose vitamin D levels were insufficient and 69% of those who were deficient.

Breast cancer is the most common cancer in women. About 184,450 cases and 40,930 deaths from the disease are expected in the United States this year.
American Society of Clinical Oncology May 15, 2008
DR. PAIS'S COMMENTS: This study, like almost all studies that have seen a correlation between Vitamin D levels and cancer or other diseases, was presented with the almost mandatory warning not to take Vit. D supplements. The concern is that you will overdose with Vitamin D thereby raising your blood levels of calcium and causing health problems.

Don't get me wrong this is biochemically possible. Which is why I highly recommend that everyone get the correct Vitamin D test done before starting supplementation. That way the correct supplement dose can be selected and periodically tracked by subsequent lab testing. No knowledgeable practitioner is liable to make a mistake if this protocol is followed. 

With this being the case I'm a bit at a loss at the inordinate fear that Vitamin D supplementation seems to provoke in medical practitioners. Especially when they routinely prescribe highly toxic chemotherapy drugs that increase your risk for future cancers, create a whole range of side effects, and incur great expense. Versus an inexpensive vitamin that can be effectively tracked with a $70 lab test. No hair loss, no fatigue, no nausea or vomiting, no liver toxicity. 

In the largest study of its kind ever carried out, German researchers reported in the journal Carcinogenesis that vitamin D protects against postmenopausal breast cancer.
Besides its role as an essential nutrient for bone health, vitamin D is also important in immune function related to cancer. Several studies have suggested that vitamin D might help protect against breast, colon, and prostate cancers, possibly by inhibiting the growth of cancer cells and stopping cancer from spreading.

Most of these previous studies have looked at the effect of vitamin D obtained from foods-such as fish, egg yolks, and butter-on breast cancer risk. Foods aren't able to satisfy the body's requirement for the vitamin by themselves. Of course, the most abundant source of vitamin D is from the body itself upon exposure of the skin to sunlight. However, due to the widespread use of sunscreens and the strong warning about time spent outdoors, vitamin D deficiency is increasingly common. This is true especially for people living at higher latitudes that are at particularly high risk for vitamin D deficiency during the winter and spring months.

This new study compared the blood levels of vitamin D in 1,394 postmenopausal breast cancer patients with those of 1,365 healthy postmenopausal women. Having a higher vitamin D level was associated with a lower risk of having breast cancer. The relationship was stronger in women who had never used hormone therapy and in women who had been pregnant two or more times. 
Carcinogenesis, doi:10.1093/carcin/bgm240
DR. PAIS'S COMMENTS: It would have been great if this study had looked at specific amounts of Vitamin D necessary for this protective effect. My preference is to have a serum hydroxy Vit. D test done to know what levels are both before and then after a supplement regime has been in place. If your MD refuses to run this test for you then 1,000IU/day is a reasonable amount. However, without the lab test there's no way of knowing whether that level of supplementation will take you to optimum levels which many think are 50-80 ng/mL.

Two studies presented at the 97th meeting of the American Association for Cancer Research (AACR) suggest a major role of vitamin D in the prevention of breast cancer. Several risk factors have been associated with an increased incidence of breast cancer. These include a positive family history of breast cancer, an early age at first menstrual cycle, and a late age at menopause (the risk increases with a higher number of menstrual cycles). Additional risk factors include a late age at the birth of the first child, the use of hormone replacement therapy, the use of oral contraceptives, a high-fat diet, and obesity.

While the role of vitamin D in breast cancer incidence has not been well explored, some epidemiological studies suggest that vitamin D deficiency increases the incidence of breast cancer. Researchers from the Samuel Lunefeld Research Institute in Toronto suggest that exposure to high levels of vitamin D during childhood and early adulthood is associated with a reduced incidence of breast cancer.(1) 

These researchers compared sun exposure and consumption of vitamin D in 576 patients with breast cancer to 1,135 women without breast cancer. Results of this study were adjusted for age, ethnicity, and education, having a first-degree relative with breast cancer, early breast-feeding, age at menarche, and age at first birth. They reported that women who worked in an outdoor job between the ages of 10 and 19 years had a 40% reduction in the incidence of breast cancer, and frequent sun exposure between the ages of 10 and 29 years of age was associated with a 35% reduction in the incidence of breast cancer. These authors suggested that these exposures during critical growth of breast tissues could be of major importance.

Researchers from the University of California at San Diego suggest that increasing doses of vitamin D to three-times the current average for Americans may lower the incidence of breast cancer.(2) These researchers evaluated the association between breast cancer recurrence and levels of 25-hydroxyvitamin D in 1,760 women.

They identified a level of 25-hydroxyvitamin D (52 nanograms/ml) that was associated with a 50% reduction in the incidence of breast cancer. In order to achieve these levels, these authors suggested that a woman would have to consume 1,000 IU or more of vitamin D per day. They also stated that typical Americans only consume approximately 320 IU per day. They also stated that toxic levels of vitamin D are in excess of 3,800 IU per day. As well, they stressed that a higher intake is needed to compensate for lack of sun exposure in many women. 
(1) Knight JA, Lesosky MR, Barnett H, et al. Potential reduction in breast cancer risk associated with vitamin D. Proceedings of the 97th AACR meeting, April 1-5, 2006. 
(2) Garland CF, Mohr SB,Gorham ED, et al. Evidence of need for increased vitamin D fortification of good based on pooled analysis of studies of serum 25-hydroxyvitamin D and breast cancer. Proceedings of the 97th AACR meeting, April 1-5, 2006. 
DR. PAIS'S COMMENTS: These and other data strongly suggest that the diet of Americans is deficient in Vitamin D at levels that are preventative of malignancy. All those years people have stayed out of the sun are catching up with us. When it comes to nutrition related health issues conventional medicine just can't get it right. This has the potential to be the biggest boondoggle since they told everybody to eat margarine 35 years ago.

Women with the highest levels of vitamin D intake are about one third less likely to develop rheumatoid arthritis (RA) than women with the lowest levels, findings from a new study suggest.

Although vitamin D is best known for its role in building bones, it also has effects on the immune system, as reported in the May 2006issue of Arthritis and Rheumatism.

To determine the effect of vitamin D intake on rheumatoid arthritis risk, data was analyzed from nearly 30,000 women, between 55 and 69 years of age, who participated in the Iowa Women's Health Study.
All of the women were rheumatoid arthritis-free at study entry in 1986, and vitamin D intake was ascertained through food frequency questionnaires.

During the 11-year follow-up period, 152 confirmed cases of rheumatoid arthritis were identified, the investigators report. Both dietary and supplemental vitamin D intake were inversely linked with rheumatoid arthritis risk, the authors found. High dietary (at least 290 IU/day) and supplemental (at least 400 IU/day) intake were associated with 28 percent and 34 percent reductions, respectively, in the risk of rheumatoid arthritis.
DR. PAIS'S COMMENTS: It is very likely that Vitamin D deficiency is the most common vitamin deficiency in this country. Given that everybody has been told to stay out of the sun for the last 20 years it's no surprise. More and more these days I'm recommending that certain patients have a Vitamin D test done (25(OH)D, also called 25-hydroxyvitamin D). 

On May 27, 2008, the Journal of the National Cancer Institute published a study proclaiming that vitamin D did not reduce prostate cancer risk in a group of aging men. Furthermore, this population-based analysis suggested that higher circulating levels of vitamin D might be associated with an increased risk of more aggressive forms of prostate cancer.

Researchers compared the concentration of vitamin D in the blood of 749 men diagnosed with prostate cancer with that of 781 men without prostate cancer. All of the men were participants in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial.

Vitamin D was measured when the men enrolled in the study, and all prostate cancer cases included in the current analysis were diagnosed 1 to 8 years after the blood samples were taken. The researchers claimed that there was no statistically significant difference in the risk of prostate cancer with increasing vitamin D concentration. 

"Results from this large prospective study of men who underwent standardized prostate cancer screening in the context of a screening trial do not support the hypothesis that higher serum vitamin D status is associated with decreased risk of prostate cancer," the authors write.
Journal of the National Cancer Institute Online May 27 2008
DR. PAIS'S COMMENTS: As usual, when a nutritional intervention for a particular disease is studied (especially cancer), multiple flaws are revealed in the supposedly scientific study. Here are some of the more glaringly obvious ones in this study:

1. Only 49 (6.3%) out of the total of 781 men diagnosed with prostate cancer in the trial were ingesting at least 1,000 IU of vitamin D in the diet every day. From the very low vitamin D blood levels of the study subjects it is likely that almost none were taking supplemental Vitamin D. In other words, none of the prostate cancer subjects had anywhere near enough Vitamin D present in their bodies to determine if it could prevent prostate cancer. So the results mean absolutely nothing if you are taking recommended amounts of Vitamin D to optimize blood levels.

2. The men diagnosed with prostate cancer in the study had a 138% greater risk of having a family history of prostate cancer. Remember, family history predisposes one to prostate cancer. By nature of this fact the study was genetically 

3. Of the 749 men diagnosed with prostate cancer in the study, 434 were diagnosed in the second year of follow-up - fully 58% of the diagnosed prostate cancers occurred during the second year of the trial. Based on how prostate cancer develops and the time it takes to reach a detectable size, most of these men diagnosed with prostate cancer during the study already had prostate cancer when the study started.

Three other prospective clinical studies have shown benefit with higher levels of circulating vitamin D and prostate cancer risk:
A 1998 US-based study showed a 20% reduced risk of prostate cancer with the highest levels of vitamin D compared with lower levels.
Nomura AM, Stemmermann GN, Lee J, et al. Serum vitamin D metabolite levels and the subsequent development of prostate cancer (Hawaii, United States). Cancer Causes Control. 1998 ; 9 ( 4 ): 425 - 432.

A Finnish study published in 2000 showed that men with vitamin D concentrations below the median had a 70% increased risk of prostate cancer compared to men with vitamin D levels above this level. More dramatically, among younger men (<52 years of age), low vitamin D increased the risk of metastatic cancer by 530%.
Ahonen MH, Tenkanen L, Teppo L, Hakama M, Tuohimaa P. Prostate cancer risk and prediagnostic serum 25-hydroxyvitamin D levels (Finland). Cancer Causes Control. 2000 ; 11 ( 9 ): 847 - 852.

A US study published in 2004 showed that men in the lowest third of vitamin D levels had a 71% greater risk of prostate cancer.
Jacobs ET, Giuliano AR, Martinez ME, Hollis BW, Reid ME, Marshall JR. Plasma levels of 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D and the risk of prostate cancer. J Steroid Biochem Mol Biol. 2004 ; 89 - 90 (1 - 5): 533 - 537.

It's difficult to argue with the numbers from these studies-530%!! This is not a case of scientists splitting hairs and consumers scratching their heads not knowing which to believe. The fundamental study errors described above seem almost designed to give a negative result. Once again an institution invested in the status quo (NCI) is downplaying a safe, simple low-cost nutritional treatment. What's offered instead? A pharmaceutical/surgical/radiological intervention that is neither safe nor simple.
Getting a little sunshine may be one way for men to cut their risk of prostate cancer. A large study presented at a cancer conference, 2/24/95, found that men with higher levels vitamin D in their blood were half as likely to develop aggressive forms of the disease than those with lower amounts.
"When you were little and your mother said, `Go outside and play,' it wasn't just to get you out of her hair," but may have been instinctive advice about something good for health, said Dr. Eric Klein, a prostate cancer specialist from the Cleveland Clinic.

He had no role in the research, which involved nearly 15,000 men in the Physicians' Health Study at Brigham and Women's Hospital and Harvard Medical School in Boston. Five years ago, this study found that men who consumed a lot of calcium had modestly higher rates of prostate cancer.
The new findings fit with that notion, because too much calcium lowers vitamin D, and are especially believable because researchers got them by measuring blood samples rather than relying on what men said they ate - an imprecision that has hurt past studies of food and cancer risk.
Blood samples were taken in 1982, when the study began. Eighteen years later, 1,082 of the men had developed prostate cancer. Their levels of two common forms of vitamin D in the stored blood samples were compared with those of 1,701 men in the study who did not get cancer.

Levels of one or the other vitamin D derivative did not make much difference in prostate cancer risk. However, men with higher levels of both had roughly half the risk of developing aggressive tumors - the kind most likely to kill - than men with lower levels, said Dr. Haojie Li, who led the study.

That is in keeping with what previous studies have shown about prostate cancer, Klein noted.
Men in northern latitudes have higher cancer death rates, and vitamin D levels are lower in older men, who are most prone to prostate cancer.

Melanin, which gives skin its color, blocks ultraviolet light that spurs vitamin D production. Blacks, who have a lot of melanin, also have the highest rates of prostate cancer.
Experiments also suggest vitamin D inhibits cell growth. "So there is some lab evidence that vitamin D may be anti-cancer," Klein said.

How much should people get? The recommended daily amount is 400 international units, but most scientists think that is probably low, Li said.

Most milk is fortified with the wrong form of vitamin D (body can't use it), and drinking a lot of it might raise the risk of prostate cancer because of its calcium content. Getting enough vitamin D from food is difficult, but doctors do not recommend supplements because they can cause unsafe levels of calcium to build up.

"If you start overloading on vitamin D you're going to cause other problems," said Dr. Durado Brooks, chief of prostate cancer research at the American Cancer Society.
DR. PAIS'S COMMENTS: This is not a prescription to just run out and start taking Vitamin D. You have to use the correct form and should only take it if you need it. And then only in the proper amount.

This study found that almost half of elderly women in high-level residential care, though not bedridden, were severely deficient in vitamin D. Being vitamin D deficient puts the elderly at more of a risk to fall and injure themselves, possibly leading to death. Vitamin D is produced in the skin when it is exposed to sunlight. It has also been proven to assist in the function of healthy bones and muscle and brain function. Lacking in either of these could cause an elderly person to fall. 
Journal of the American Geriatrics Society December 3, 2003
DR. PAIS'S COMMENTS: Conventional medicine may now be waking up to the idea that vitamin D is deficient in many individuals. Excuses of not enough information, or 'no scientific research' don't cut it. This study is almost 4 years old. Why do most docs ignore vitamin D? One reason may be that deficiency is corrected by lifestyle changes and supplementation. Not drugs or surgery.

Here are some pages that are of particular interest:

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As is often the case, a recent new patient asked if I would review their choice and use of supplements and herbs. Why does this happen so often? For many, taking a vitamin or herb is their introduction to natural medicine. Their desire to be healthier drives them to take supplements and herbs. The death, pain, discomfort, and side effects experienced with over the counter and prescription drugs compel people to look elsewhere. It's very different with supplements and herbs which, when used correctly, have an incredibly low risk of harm.

Some people take this to an extreme and take every supplement or herb that someone tells them is 'good for them'. It might be a clerk, an internet 'expert' source, or a friend who is marketing the latest or greatest fad. Most of these individuals or companies have no professional training or experience in the medical use of the supplements or herbs that they're selling. The people they're selling to come into my office with 5, 10, 15, or more supplements that they're taking. Sometimes it's been so long since they started taking them that they don't remember why they're doing it. When I ask, they can't tell me what, if anything, a particular product is doing for them. Yet, they can be quite fearful of stopping any of these items, as if their health would careen off a precipice without them.

Why do I think my approach is any different? Partly, it's because of my background. I've literally been working with nutritional supplements since 1974. That's 36 years assessing the quality and effectiveness of supplements. Beginning in 1980 I started working with Western and Chinese herbs. The quality of herbs used and how they're combined together has the greatest effect on the efficacy of the final product. Because I've grown, identified, harvested, and produced medicinal herbal products I recognize a good formula when I see one.

Licensed naturopaths like me receive the most extensive academic and clinical training in the use of nutritional supplements and herbal medicines of any professional in the United States. Nothing can substitute for such hands on experience, especially when you see, and are responsible for, the results of your treatments. Very different from the clerk in the store, or coworker who's part of a MLM scheme. 

What I'm offering to is easy access to this experience and training. Both for you and your family. If you have questions about the supplements or herbs you are taking, or are thinking about taking, now is the time to ask. Send me an email with the brand and name of the product you're taking. Let me know that you want to bring the bottles in at your next visit, so I can see what you're taking. Start a discussion on my Facebook fan page. Either way I'll give you honest feedback about what I think is good, or what isn't. We'll fine tune what you're taking to maximize effect and eliminate waste. 

Let me hear from you and we'll get started.

For a long time I looked for a home Vitamin D test. One that would be simple, easy, and accurate to do on your own. With a 'blood spot' kit from Doctors Data, a few drops of blood from a quick and nearly painless nick of the finger, placed on a filter paper to dry are all that is needed. The total 25 (OH) Vitamin D is then determined by liquid chromatography/tandem mass spectrometry (LC-MS/MS). This method has been shown to be as accurate as the assay standard.

Doctors Data, outside of Chicago IL, provides home test kits to test your Vitamin D levels. The cost is $70.

If you are interested in getting a Vitamin D test done through my office please prepay so I can order you a kit. Then you can either pick it up at my office or have it shipped to your home. Once you've taken the sample and sent it back to Doctors Data, it's only a matter of time before your results are sent back to me. I can even look at them online before the mail arrives.

If your doctor has refused to order a Vitamin D test or worse, ordered the wrong one, this is the fastest, least expensive, most accurate way to do it ourselves. Once we know what your Vitamin D levels are, the next step is making sure that you achieve optimum levels for prevention of disease and maintenance of health.

I am often asked what supplements I recommend. Many of you have been surprised to discover that I favor food over pills; lifestyle changes over fads. I have been working with nutrition for over 30 years, herbs for over 20 years. Where and when appropriate I recommend them to my patients. I strive to act from knowledge, experience, and research.  Emerson Ecologics (800-654-4432) carries almost all of the nutritional supplements and botanical extracts that I think are useful. Their customer service is excellent and their delivery is reliable (often only 2-3 days to this region). It's a great way to get physician quality products at reasonable prices.   To offset the cost of shipping, reference my name when you establish your account and receive a 10% discount on every order. At the same time, I receive a percentage of each supplement sale. If you have any questions about these items feel free to email me.  
That's it for this issue of Naturopathic News. If you've thought a bit extra or learned something new, then I achieved my goal. As usual, if you have questions or concerns brought up by these subjects, let me know. 
Gregory Pais, ND, DHANP
580 E. 3rd. St.
Williamsport PA 17701
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