International Questions and Answers

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International Questions and Answers

 

 

 

Fri, 14 May 2010 02:00:00 -0400

 

 

 

John Cannell, M.D. <vitamindcouncil

 

 

 

vitamindcouncil

 

 

 

 

 

 

The Vitamin D Newsletter

May 14, 2010

International Questions and Answers

This is a periodic newsletter from

the Vitamin D Council, a non-profit trying to end the epidemic of

vitamin D deficiency. If you want to , go to the end of this

newsletter. If you have not d, you can do so on the Vitamin D Councils website.

Dear Dr. Cannell:

As a nutritionist, I am preparing

my own website to spread the word about vitamin D to the German

speaking parts of Europe. Germans are not allowed to import

pharmaceuticals into Europe on our own. Higher dose supplements are

declared medication by customs. Customs has the right to search every

parcel from foreign countries and if products are found inside that are

deemed medication they might be destroyed without further notice to the

recipient. That means that a European government agency decided which

vitamins and minerals in which forms and doses are necessary for the

European people and may be used as supplements.

Thank you for your good work!

Hans, Germany

Dear Hans:

What you describe may be coming to

the USA. For now, sunshine during the German summers, safe and sensible

use of sun-tanning booths in the winter, or taking 12 of the 400 IU

tablets/day of the vitamin D that is available in Germany may be the

only legal way to obtain enough vitamin D in Germany. However, I

believe Bio Tech Pharmacal ships overseas. E-mail their

customer service at customerservice. Remember, if you use sun-tanning

beds; ask for either the full-spectrum or the older type of

low-pressure beds; do not use the high-pressure UVA beds.

John Cannell

Dear Dr. Cannell:

My father and I have had our 25 OH

Vitamin D tests in Canada, but have received the results in nmol/L. I

am stunned that your website does not appear to address how to convert

these units to the units you use, ng/ml. I found a web blog that

claimed that to convert you divide nmol/L by 2.5 to get ng/ml, but I

would greatly appreciate a confirmation of this, and I strongly suggest

this tidbit needs to be added to your web site.

Thank you,

Seth, Vancouver

Dear Seth:

Yes, divide nmol/L by 2.5 to get

ng/ml. In the USA, all labs report 25(OH)D levels as ng/ml so no

division is needed. As far as our website goes, the conversion is now

on it, thank you. The English company Minervation is well into a

two-year project of greatly improving our website. Dr. William Grant, a

member of our Board, is working closely with Minervation to get the

science right. The current website began in 2003 when I spent several

months writing it and my son then published it on the internet, so it

is far from perfect.

John Cannell

Dear Dr. Cannell:

 

This is so impressive what

this kid is doing, it would be neat if there were some way the Council

could endorse him: http://www.shineonscotland.org.uk/

Mary, Scotland

Dear Mary:

Thanks for the link. Quite a kid.

We will take steps to endorse and encourage him.

John Cannell

Dear Dr Cannell:

 

I have been reading your newsletter with great interest for a few

years. I am a French doctor, specialist in Rehabilitation Medicine, and

am very much aware of the crucial role of vitamin D.

 

Having followed your action to promote vitamin D, I have written a book

on this subject called Soleil, Mensonge et Propagande," which means

"Sun, Lies and Propaganda.

 

It gives the same message as yours, to the French public. Again "bravo"

for the Vitamin D Council!

 

Dr Brigitte Houssin, MD, France

Dear Dr. Houssin:

Congratulations on your book.

Readers who want to buy your book in French should just Google the

French title and buy it on Amazon.

John Cannell

Dear Dr. Cannell:

I am mother of 7 year-old boy with

autism, I am medical doctor, we live in Rome Italy, I have read most of

your papers, and I was happy to read your theory regarding autism and

low vitamin D. I am originally from Somalia, and as you know already

the research done in Minneapolis and Sweden documented high incidence

in Somali emigrants, probably due to low level of Vitamin D.

The Somali people usually are not

fish consumers, even though the most important thing to add is about

Somali women/mothers, most of these women cover themselves in Muslim

tradition more in Europe than in Somalia, and some of them even use

lightening creams that makes there skin more light and most of women

that use these creams avoid the sun, because it can cause skin

discoloration.

Actually, I have been treating my

autistic son with Vitamin D for 11 months, local product that contains

5 mcg per 1 drop of Calcifediolo. He takes 10 drops a day and I see his

language more fluent, and he is really happier and more social. Do you

think this dose is enough? My son is suspected to have mitochondrial

disorder, his muscle enzymes are alliterated, so he is seeing

mitochondrial expert to decide soon if we should do muscle biopsy? Do

you think there could be any correlation about mitochondrial issue and

Vitamin D??

Sincerely,

Dr. Awolla Fur, Italy

Dear Dr. Fur:

Calcifediolo is 25(OH)D, not

vitamin D 3, and is no longer available for prescription in the USA.

The dose of 25(OH)D is considerably less than the dose of vitamin D3.

Your son appears to be on 50 mcg (2,000 IU) of 25(OH)D, which is too

much, reduce the dose by half and obtain frequent 25(OH)D levels and

then titrate the dose up until his 25(OH)D is between 100 and 150 ng/ml

(250 375 nmol/L). So-called mitochondrial disorders are common in

autism; I suspect but do not know that they will improve with

chronic vitamin D treatment. I doubt a muscle biopsy will add any

useful information to his treatment.

John Cannell

Dear Dr. Cannell:

I am the Somali medical doctor

from Italy. My son was responding well with Calcifediolo treatment, no

Candida, no regression, just doing fine, I got your email and got him a

25(OH)D test. The result was more than 150ng/ml (in our laboratory

normal value is 8.6-54.8ng/Ml). We stopped the Calcifediolo and

repeated the testing 6 weeks later and his 25(OH)D was 80ng/ml and

other vitamin D was 101.

After stopping the Calcifediolo he

started to regress, he was not at all improving, he started to have

hyperactivity, and started to have new symptom, which is chewing his

shirt, so we decided recently to introduce 4,000 IU of Ddrops D3

Carlson ( 2 drops a day), for 20 days, and we have seen really good

improvement.

He is more connected, talking much

more, and responding more quickly the questions that are asked. At the

moment he is taking only 1 drop a day with only 2.0000 IU Carlson, I

will appreciate if you can give me any support how we proceed from now,

and what doses we can use? And for how long?

Thank you again. God bless you

Dr. Awolla A.Fur, Italy

Dear Dr. Fur:

I am glad he is now on Ddrops, which is vitamin D3. As he has

already demonstrated a treatment response, I suspect his autism will

steadily improve on vitamin D. Autistic children need between 2,000 and

5,000 IU per every 25 pounds of body weight of vitamin D3, per day. I

suspect the other vitamin D you wrote about was 1,25(OH)2D. Only obtain

a 25(OH)D blood test as a 1,25(OH)2D will add nothing to his treatment.

Once you find a vitamin D3 dose

that stabilizes his 25(OH)D between 100 and 150 ng/ml, keep that dose

indefinitely with frequent checks of his 25(OH)D levels. In spite of

his dark skin, his 25(OH)D levels may increase some in the summer if he

is outside, so the apparent 25(OH)D response to vitamin D3 may appear

to be more robust in the spring/summer than the fall/winter. I suspect,

but do not know, that after several years of levels between 100 and 150

ng/ml, you can begin to slowly lower the dose without an exacerbation

of symptoms. Avoid rapid changes in dose, once he is in the range of

100 to 150 ng/ml.

John Cannell

Dear Dr. Cannell:

I have a four-month-old infant and

I am worried because I only took a prenatal vitamin during my pregnancy

but no extra vitamin D. I am breastfeeding but I give him formula as

well as breast milk. Do I need to give him extra vitamin D?

Jeanne, England

Dear Jeanne:

Yes, you do. In fact, CDC

researchers just announced that less than 25% of U.S. infants are

getting the outdated recommended amount of vitamin D (400 IU/day). I

suspect the situation is worse in England. Dr. Cria Perrine and her

colleagues at the CDC analyzed questionnaires sent to over 15,000

mothers with infants ranging in age from 1-10 months.

Perrine CG et al.Adherence to

Vitamin D Recommendations Among US Infants. Pediatrics. 2010 Mar 22.

[Epub ahead of print]

The breast milk of vitamin D

deficient mothers contains little vitamin D and virtually all mothers

are deficient, thus breast milk usually has little vitamin D. Dr.

Perrine found that only about 10% of breast-feeding infants are

supplemented to meet the 400 IU/day recommendation; more surprising,

only about 30% of formula-fed infants were getting 300 IU/day, mainly

because few infants consume the one liter of formula needed to do so.

One bad sign, Dr. Perrine

reiterated the 1999 American Academy of Pediatrics sunshine warning,

which amounts to child abuse, stating, children under the age of 6

months should be kept out of the sun altogether and that those aged 6

months or older should wear protective clothing and sunscreen to

minimize sun exposure. One good sign, WebMD mentioned that adequate

amounts of vitamin D might prevent respiratory infections in infants.

Boyles S. CDC: Babies Don't Get

Enough Vitamin D. WebMD, March 22, 2010

The vitamin D Council recommends

that breastfeeding infants under one year of age take 1,000 IU/day

unless the mother takes 5,000 IU/day, in which case the infants will

get all they need from breast milk. Formula fed infants need an extra

600 IU/day. Carlson Ddrops, either 400, 1,000 or 2,000

IU/drop are available at most health food stores and on the internet;

they are an easy way to keep your infant vitamin D sufficient. I

understand that similar dropper products are available in Englands

health food stores.

By the way, Dr. Carol Wagner and

Bruce Hollis have just presented their data about pregnant women and

vitamin D.

Boyles S. High Doses of Vitamin D

May Cut Pregnancy Risks: Study Shows 4,000 IU a Day of Vitamin D May

Reduce Preterm Birth and Other Risks. WebMd, May 4, 2010.

Their study had two treatment

arms; pregnant women took either 2,000 IU/day and 4,000 IU/day. In

Belgium, Dr. Hollis reported their findings forced them to discontinue

the 2,000 IU/day treatment arm for ethical reasons: it was associated

with more obstetrical complications than the 4,000 IU/day treatment arm.

John Cannell

Dear Dr. Cannell:

Is there anything out there about

vitamin D and libido? I am asking because I have noticed an increase in

my libido (I am a 48-year-old male who has been getting 5,000 IU/day

shipped to me in France from Bio Tech Pharmacal for about a year.)

Philippe, France

Dear Philippe:

I know of no studies measuring

male libido and vitamin D but Dr. Wehr and colleagues, at the Medical

University of Graz in Austria, just published a surprising study

showing that testosterone levels are directly associated with vitamin D

levels (measured with the DiaSorin technique) and testosterone levels

vary with the seasons, in concert with vitamin D levels. Furthermore,

the men with very low testosterone levels had very low vitamin D

levels. This study does not prove, like any association study, that

vitamin D increases testosterone levels. It may be that sun-exposure in

the summer is responsible for both higher vitamin D levels and higher

testosterone levels.

Wehr E et al. Association of

vitamin D status with serum androgen levels in men. Clin Endocrinol

(Oxf). 2009 Dec 29. [Epub ahead of print]

By the way, the New York Daily

News got it wrong, nothing in the Wehr study talks about vitamin D

increasing male libido.

Dominguez R. Suntanning, and the

doses of vitamin D it provides, found to boost male sex drive: study.

February 2nd 2010

John Cannell

Dear Dr. Cannell:

 

Thanks for all your work on

Vitamin D, I have been supplementing with vitamin D and also found a

doctor who will test get my blood levels regularly. I am wondering,

does the vitamin A drug, Isotretinoin, compete similarly to vitamin A

with vitamin D receptors?

 

Isotretinoin is often prescribed for inflammatory skin conditions; it

is supposed to shrink the sebaceous glands and act as an

anti-inflammatory, therefore helping acne and rosacea. Do you think it

can have similar negative effects as retinol on Vitamin D usefulness? I

am quite concerned after reading your February Newsletter: "Vitamin D,

Vitamin A, and Cancer"

 

Many people might be taking or have taken Isotretinoin for acne and I

would greatly appreciate your insights on the effects of Accutane (even

low doses like 2.5mg/day) on Vitamin D.

 

Eric, Scotland

Dear Eric:

Isotretinoin or 13-cis-Retinoic

Acid (Accutane in the USA) is a retinoid used in severe acne and

rosacea as well as in cancer chemotherapy. It may have the same effects

on the vitamin D receptor as other retinols. It certainly interferes

with vitamin D metabolism.

Rødland O, et al. Serum levels of

vitamin D metabolites in isotretinoin-treated acne patients. Acta Derm

Venereol. 1992;72(3):217-9.

For those taking Isotretinoin for

cancer, continue doing what your oncologist says to do, but also get

your 25(OH)D to at least 100 ng/ml. If you are taking Isotretinoin for

acne, my advice is to stop the Isotretinoin and take adequate doses of

vitamin D.

In 1938, Dr. Merlin Maynard showed

vitamin D helped acne more than one of the most effective treatments of

all time, x-ray treatment. You can download his entire paper for free.

Maynard MT. Vitamin D in acne, a

comparison with x-ray treatment. California and Western Medicine: 49

(2);127-132

Dr. Maynard wrote beautifully:

There is probably no skin disease

of greater importance to the human race than acne. It is undoubtedly

our commonest skin disease, and it is rare that any individual reaches

maturity without having had it in one of its phases. It is a disease of

considerable economic importance, as the disfiguring scars of a severe

case are never completely obliterated. It is also a disease of youth.

It attains its most noxious form at the time the individual first has

to earn his own living. It is undoubtedly responsible for many failures

in getting business positions. It is also the basis for inferiority

complexes and discouragement in young people.

Dr. Maynard published a long case

series. In his earlier days, he used x-ray treatment for acne, but when

he started using viosterol (vitamin D2) he stopped using x-ray

treatment. In reviewing his cases, he found x-ray treatment led to

favorable results 48% of the time but vitamin D did so 76% of the time;

he used between 5,000 and 14,000 IU per day. Vitamin D3 may work even

better than D2, if acne patients take adequate doses, like 10,000

IU/day with frequent 25(OH)D levels.

In summary, he said:

I believe I may say that at no

time in my dermatological experience have I felt such complete

satisfaction with a treatment as I have with the cases of this series.

I know that vitamin D is an imperfect weapon to slay this disfiguring

disease, but it undoubtedly gives one a feeling of being well defended.

From the patients' viewpoint, it has left little to be desired, as they

find themselves improving, both in appearance and in general

well-being. Many have expressed the sentiment, Never felt better.

In 2008, the mechanism of action

of vitamin D in the skin was the subject of a lengthy review:

Schauber J, Gallo RL. The vitamin

D pathway: a new target for control of the skin's immune response? Exp

Dermatol. 2008 Aug;17(8):633-9.

Theoretically, rosacea should not

respond to vitamin D, just the opposite, but readers have told me it

does. However, if you have been on Isotretinoin, it may take months or

years for the excessive vitamin A to get out of your system. The excess

vitamin A may continue to compete for the vitamin Ds receptors

attention and, until the vitamin A is gone, one may not see the full

effects of vitamin D. By the way, just ask any acne patient if their

acne gets better after a week of sunning at the beach.

John Cannell

Dear Dr. Cannell:

Why are you against vitamin A?

People need to take all vitamins for good health.

Susan, Australia

Dear Susan:

The body needs all vitamins for

good health but this hardly means one has to take all vitamins as

supplements for good health. A balanced diet with varied food

consumption, including vegetables, seeds and nuts, cold water fatty

fish, dairy, red meat, and fruit, will supply almost all needed

vitamins with the absolute exception of vitamin D, and possible

exception of magnesium, zinc, potassium, and vitamin K2. Remember,

nature never intended you to put vitamin D in your mouth; nature

intended you to make it in your skin.

As far a vitamin A, the question

is, do we get enough in our diet. The answer appears to be that we do,

maybe way too much due to widespread food fortification and the use of

vitamin A supplements, vitamin A in multivitamins, and cod liver oil.

Beta-carotene is fine but if your multivitamin says retinyl acetate or

retinyl palmitate, 5,000 IU, do not take it.

The problem of widespread vitamin

A toxicity is so perverse; it includes the monkeys and apes we use in

experiments, perhaps those we keep in our zoos. Drs. Joseph Dever and

Sherry Tanumihardjo, of the University of Wisconsin, reported that

liver biopsies of such primates show evidence of liver damage from the

vitamin A. The reason is that way too much vitamin A is added to

primate chow.

Dever JT, Tanumihardjo

SA. Hypervitaminosis A in experimental nonhuman primates: evidence,

causes, and the road to recovery. Am J Primatol. 2009 Oct;71(10):813-6.

This is an excellent paper for

other reasons. Dr. Dever reminds us that blood retinol levels are

useless to detect either vitamin A deficiency or vitamin A toxicity,

and that the rate limiting step (how the body controls vitamin A

levels) occurs with an enzyme in the intestine (carotenoid

monooxygenase). The body simply makes the amount of retinol needed from

orange-colored vegetables and fruit, but does not make retinol if you

do not need it. That is why you can turn yourself yellow by drinking

large amounts of carrot juice but you apparently cannot make yourself

vitamin A toxic by doing so.

When you take retinyl acetate or

retinyl palmitate, or cod liver oil, you bypass this intestinal

regulatory system and dump preformed retinol into a closed system that

has no good way of getting rid of it. This also explains why many

studies from developed countries (where vitamin A toxicity is common)

show one does not make much retinol from carotenoids, while studies

from underdeveloped countries (where vitamin A deficiency is the rule)

show that one does make it.

In 2008, Dr. Anthony Mawson, of

the University of Mississippi, discussed evidence that taking vitamin

A, especially during pregnancy, may account for some of the aggressive

disorders (like ADHD, irritability, and conduct disorders). In fact, he

discusses the numerous case reports associating vitamin A, including

Accutane, with aggression.

Mawson AR. On the association

between low resting heart rate and chronic aggression: retinoid

toxicity hypothesis. Prog Neuropsychopharmacol Biol Psychiatry. 2009

Mar 17;33(2):205-13.

I am no friend of the lots of all

vitamins crowd. Take what you need and leave the rest, and the only

way to know what you need is to do an accurate dietary evaluation of

what you are eating.

John Cannell

Dear Dr. Cannell:

I am a naturopath in Montréal,

Canada. I work primarily in mental health. I did a search on MDConsult

recently for "Differential diagnosis of psychosis." One of the

differential diagnoses in the list was vitamin D deficiency. I am

unable to find any research that supports that, and that list had no

citations. Do you know anything about it?

I have a patient who recently

experienced some of the most extreme psychosis of his life. During that

time, I measured his Vitamin D. It was too low to be detected! I

started him on 5,000 IU per day and had measured it a few months later,

when he was doing much better, and it was 22 ng/ml. I thought there was

a relationship between the deficiency and the psychosis, but could not

find anything on PubMed or anywhere else about the connection.

Any thoughts on that?

Melissa, Canada

Dear Melissa:

This is good news; however, I am

not aware of any papers on the treatment of psychosis with vitamin D.

At my hospital, which now has a policy to test all new patients for

vitamin D deficiency, several of us have noticed that a few psychotic

patients seem to get remarkably better on vitamin D, and others can

reduce the dose of their meds, once their vitamin D deficiency is

treated. However, the vast majority of patients must stay on meds or

they relapse. However, no one, to my knowledge, has treated psychotic

patients with pharmaceutical doses, like 20,000 IU per day. It would

not surprise me at all if researchers found that dose to be effective

treatment in some cases of psychosis.

The scientific community has never

researched the issue of using vitamin D as a drug, that is, as a

pharmaceutical. If one was free to use pharmaceutical doses, as

psychiatrists in private practice are free to do, they could rapidly

lend some light to the subject by treating psychotic patients with both

antipsychotic meds and with 20,000 IU per day and carefully follow

25(OH)D, calcium, and clinical course. I suspect they would find a

vitamin D treatment effect. If they did such a case series, I would

publish their reports in this newsletter, be they negative or positive.

John Cannell

Dear Dr. Cannell:

I work with the Somali immigrant

community in Ottawa. If you see how healthy these immigrants are when

they come here and how terrible their health is after a few years it is

hard to see how it could be anything but vitamin D. Why do the health

officials in Canada do nothing?

Gail, Ottawa

Dear Gail:

What is going on in Ottawa is a

crime against people of color, just as what is going on against African

Americans in the USA is a crime. It is not just autism, but

schizophrenia, depression, heart attack, stroke, diabetes, and

hypertension, are all diseases associated with vitamin D deficiency and

also associated with dark skin in temperate latitudes.

Starved for Sunlight Immigrants

struggle with declining health. CBC News, 2/17/2010

African Americans die almost eight

years younger than Whites do, due to the diseases of vitamin D

deficiency. I hoped the Obama administration might do something, but so

far nothing. Perhaps we should file our civil rights complaint again,

like the one we filed in 2005, which then Attorney General Alberto

Gonzales summarily dismissed:

http://www.vitamindcouncil.org/PDFs/2005pr-doj-civil-rights-complaint.pdf

John Cannell, MD

Executive Director

Vitamin D Council

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