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"March 18, 2009 | Marlene Busko Palm Harbor, FL - In a large study of adolescents, low serum levels of 25-dihydroxyvitamin D (25[OH]D) strongly predicted prevalence of hypertension, hyperglycemia, and metabolic syndrome [1]. The findings were reported at the AHA 49th Annual Conference on Cardiovascular Disease Epidemiology and Prevention. Adolescents with vitamin-D levels in the lowest quartile were almost four times more likely to have metabolic syndrome than those with vitamin-D levels in the highest quartile. "I think that is quite alarming," lead author Dr Jared P Reis (Johns Hopkins Medical Institutions, Baltimore, MD) said in an AHA podcast issued to the media."

Podiatrists provide medical and surgical care for people suffering foot, ankle, and lower leg problems. They diagnose illnesses, treat injuries, and perform surgery.

A German group has now shown that the important inflammatory marker, tumor necrosis factor (TNF), is also reduced by vitamin D supplementation. Many studies have implicated increased TNF levels in promoting cancer. In this study, a modest vitamin D dose of 3320 units (83 micrograms) was given vs. placebo. The 25-hydroxy D level reached in the treated group was 34.2 ng/ml (85.5 nmol/L), which resulted in a 26.5% reduction in TNF compared with 18.7% reduction (?) in the placebo group.

Why would vitamin D be prescribed when vitamin D3 is available over-the-counter? Let's review the known differences between vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol): --D3 is the human form; D2 is the non-human form found in plants. --Dose for dose, D3 is more effective at raising blood levels of 25-hydroxy vitamin D than D2. It requires roughly twice to 250% of the dose of D2 to match that of D3 (Trang H et al 1998). --D2 blood levels don't yield long-term sustained levels of 25-hydroxy vitamin D as does D3. When examined as a 28-day area under the curve (AUC--a superior measure of biologic exposure), D3 yields better than a 300% increased potency compared to D2. This means that it requires around 50,000 units D2 to match the effects of 15,000 units D3 (Armas LA et al 2004). --D2 has lower binding affinity for vitamin D-binding protein, compared to D3 --Mitochondrial vitamin D 25-hydroxylase converts D3 to the 25-hydroxylated form five times more rapidly than D2. --As we age, the ability to metabolize D2 is dramatically reduced, while D3 is not subject to this phenomenon

Add vitamin D to achieve our target serum level . . . HDL jumps to 50, 60, 70, even 90 mg/dl. The first few times this occurred, I thought it was an error or fluke. But now that I've witnessed this effect many dozens of time, I am convinced that it is real. Just today, I saw a 40-year old man whose starting HDL was 25 mg/dl increase to 87 mg/dl. Responses like this are supposed to be impossible. Before vitamin D, I had never witnessed increases of this magnitude.

"From 1955 to 1990, all infants in East Germany received 600,000 IU of Vitamin D every three months for a total of 3,600,000 IU at age 18 months. With the 400 IU/day recommendation of the American Pediatric Association in mind, I ran across this amazing paper while surfing Medline for Vitamin D. According to this paper, all infants in the German Democratic Republic (East Germany) received dangerously high doses of Vitamin D every three months in their doctors office. The policy was in place for 35 years. The first 600,000 IU dose was given at three months and then every three months until the child was 18 months of age. This works out to an average of 6,000 IU per day (actually, for several technical reasons it is not equivalent) for 18 months. The authors collected blood before the dose and then 2 weeks after the quarterly dose to obtain 25(OH)D, 1,25(OH)D, and calcium levels on a total of 43 infants. Before the first dose, at 3 months of age, the average infant was extremely deficient (median 25(OH)D of 7 ng/ml). Two weeks after the first dose the average 25(OH)D level was 120 ng/ml, the second dose 170 ng/ml, the third dose, 180 ng/ml, the fourth dose, 144 ng/ml, the fifth dose, 110 ng/ml and after the sixth and final dose, 3.6 million total units, at age 18 months, the children had mean levels of 100 ng/ml. That is, by the 15 and 18 month doses, the children were beginning to effectively handle these massive doses. The highest level recorded in any of the 43 infants was 408 ng/ml at age 9 months, two weeks after the third 600,000 IU dose. Thirty-four percent of the infants had at least one episode of hypercalcemia but only 3 had an elevated serum 1,25(OH)D. The authors reported that all the infants appeared healthy, even the infant with a level of 408 ng/ml, that is, no clinical toxicity was noted in any of these infants."

"One of the surprises over the past year has been all the research regarding Vitamin D and brain health. Give that many people are spending less time outdoors and more time in front of their computers, we all should be concerned, as Vitamin D comes in part from our exposure to the sun. Low Vitamin D levels have been associated with pain, depression, MS, cancer and now perhaps even dementia. Here are the results of a new study that should cause all of us to pay attention. I frequently check the Vitamin D levels in my patients and frrequently see that they are below the optimal level. Get your levels checked if you have any of these concerns. A new large-scale senior population study has found that a lack of vitamin D in the elderly could be linked to cognitive impairment. The study, conducted on almost 2,000 adults over the age of 65, is the first of its scale to identify this relationship, and prompted researchers to suggest vitamin D supplementation as a possible means of reducing the risk of dementia. "

"Lisa is one of early success stories: a heart scan score of 447 in her early 40's, modest reduction of CT heart scan score three years ago. However, Lisa had a difficult time locating oil-based vitamin D. There has, in fact, been a national run on vitamin D and I'm told that even manufacturers are scrambling to keep up with the booming demand. So, she bought tablets instead and was taking 3000 units per day. She came in for a routine check. Lisa's 25-OH-vitamin D3: 17 ng/ml, signifying severe deficiency, the same as if she were taking nothing at all. (Recall that we aim for 50 ng/ml.) In other words, vitamin D tablets do not work. It is shameful. I see numerous women taking calcium tablets with D--the vitamin D does not work. I've actually seen blood levels of zero on these preparations. "

"Good research is good for medicine. The only thing more important than good research is ethical research. The February 16th issue of the New England Journal of Medicine (NEJM) had a research paper on vitamin D and colon cancer. Was it good research? Was it ethical research? At stake are the lives of 36,000 older American women who agreed to participate in the Women's Health Initiative. "

"If you're running low on vitamin D - as an estimated 70 percent of the U.S. population is - your immune system may not be functioning as well as it should. As a result, you may be more vulnerable to infectious diseases than you would if your vitamin D levels were optimal. Worse, you could be at higher than normal risk of a long list of diseases including heart disease and several kinds of cancer. A report recently published journal, Future Microbiology, highlighted research at the Linus Pauling Institute at Oregon State University, which has shown that vitamin D induces expression of an antimicrobial peptide gene called cathelicidin that is the "first line of defense" in the immune system's response to minor wounds, cuts and bacterial and viral infections. The regulation of cathelicidin by vitamin D could help explain its vital role in immune function. The report noted that vitamin D is a key cofactor in reducing inflammation, in blood pressure control and helping to protect against heart disease. Author Adrian Gombart explains that there is still much to explore about D's mechanisms of action, the potential use of synthetic analogs of it in new treatments, and its duty in fighting infection."

"Vitamin D, often referred to as the "sunshine vitamin," is actually a fat-soluble hormone that the body can synthesize naturally. There are several forms, including two that are important to humans: D2 and D3. Vitamin D2 (ergocalciferol) is synthesized by plants, and vitamin D3 (cholecalciferol) is synthesized by humans when skin is exposed to ultraviolet-B (UVB) rays from sunlight. The active form of the vitamin is calcitriol, synthesized from either D2 or D3 in the kidneys. Vitamin D helps to maintain normal blood levels of calcium and phosphorus"