Category Archives: Vitamin D - Page 2

NZ Man Left for Dead by Doctors, Cured by Vitamin C

Posted by on August 26, 2010 23 comments

Modern doctors are often deeply over-invested in the use of drugs, and amazingly ignorant of the power of the human immune system, when supported by a healthy diet and optimal nutrition, to defeat disease.

They sometimes exhaust their repertoire of drugs without ever considering using nutritional supplements to support the patient’s immune defense.

An extraordinary illustration comes from New Zealand. It began when Alan Smith, a New Zealand farmer, contracted swine flu:

He caught the Swine Flu (probably while on a fishing trip in Fiji), so badly that his lungs had “white out”, which is to say they were so full of fluid that they didn’t show up on an x-ray. The doctors also said he had got leukemia and he ended up being put on a life support machine.

The doctors told the family the machine should be turned off … [1]

The diagnosis of leukemia is suspicious. Both infections and leukemia lead to “leukocytosis” or a very high white blood cell count. In one case the white blood cells are multiplying to fight the infection, in the other a malignant population is multiplying. The difference is that in leukemia the population is monoclonal, i.e. all the new white blood cells are genetically identical, while in normal people with infections the white blood cells are created with genetic diversity. (Keywords for those who wish to investigate: T-cell antigen repertoire and B-cell immunoglobulin repertoire.)

As subsequent events showed, the leukemia “diagnosis” was mistaken. I wonder if it was made just for “family management” – in order to help persuade the family his case was hopeless and support the recommendation to end life support.

… but the family asked that he be given high dosages of Vitamin C. After a fight (one of many), one of the doctors agreed. Alan began getting better; his lungs showed pockets of air. Then he began to get worse and the family found out the doctors had stopped the Vit C.

Many more fights ensued, the patient getting better while having the Vit C, and getting worse when he was taken off. Alan’s wife describes one of the doctors sitting back in his chair, arms folded, rolling his eyes, looking at the ceiling, telling her that no way could the vitamin C be helping. The family hired a lawyer, forcing the doctors to continue the vit C treatment (albeit in slow dosage, until he got better enough to eat and his wife brought along sachets of large dosage herself for him to take).

Eventually Alan fully recovered, no trace of leukemia even. [1]

He should have been given high doses of vitamin D and iodine as well. Iodine supports leukocyte respiratory bursts of reactive oxygen species which destroy pathogens; vitamin C supports respiratory bursts by recycling glutathione and providing antioxidant protection for leukocytes against their own respiratory bursts, and also supports anti-viral immunity; vitamin D creates antimicrobial peptides that kill many pathogens.

Other possibly beneficial supplements in cases of elevated leukocyte counts due to infection: selenium, to support both glutathione and iodine/thyroid function; iron, for myeloperoxidase (respiratory burst enzyme) and catalase (antioxidant defense); N-acetyl cysteine (for glutathione production) and glutathione; zinc and copper (for the anti-oxidant zinc-copper superoxide dismutase).

Thank goodness the family had the sense to try vitamin C, and that that was enough for him to recover. It would have been a shame if he died for lack of vitamin D and iodine.

New Zealand was a pioneer of socialized medicine in the English-speaking world. Economists say that people respond to incentives; one wonders if the doctors were more motivated to tend to the interests of the bureaucrats who controlled their budgets, than to the health of the family and patient who weren’t paying them. Perhaps “free” medical care has unexpected costs.

References

[1] “Indictment of Our Medical Profession,” New Zealand Conservative, http://nzconservative.blogspot.com/2010/08/indictment-of-our-medical-profession.html; hat tip to Jewel at http://health.groups.yahoo.com/group/infection-cortisol/message/1760.

Vitamin D Dysregulation in Chronic Infectious Diseases

Posted by on August 21, 2010 45 comments

Commenter qualia recently got his serum 25-hydroxy vitamin D levels tested and found a surprising result: He had doubled his vitamin D intake from 5,000 IU to 10,000 IU per day, but his 25(OH)D levels didn’t budge – they were at 61 and 62 nmol/l, equivalent to 24.4 ng/ml in American units.

24 ng/ml is well below the optimal level for healthy people of 40 ng/ml. When a healthy person supplements vitamin D, the serum 25(OH)D level usually rises linearly with dose up to about 40 ng/ml, then it rises very slowly thereafter as the body tries to keep 25(OH)D from rising by putting vitamin D into storage.

So it was natural for qualia to expect his serum 25(OH)D level to rise when he doubled his dose.

But it didn’t. The stability of his 25(OH)D levels suggests that his body has reached an equilibrium at 24 ng/ml. Instead of plateauing at 40 ng/ml with abundant vitamin D3 as a healthy person would, he is plateauing at a lower level.

Why does that happen?

Well, I don’t know. But I would like to provide qualia with a little bit of background, because this could be a clue that helps diagnose his condition and optimize treatments.

Normal vitamin D regulation strictly controls 1,25D levels

I suggested in the comment thread that qualia get his 1,25D levels measured as well as 25(OH)D.

Levels of 1,25D are not routinely measured, even in scientific studies, because they rarely vary. Blood levels of 1,25D control calcium homeostasis and are tightly regulated. In healthy people, as vitamin D intake rises from zero, serum 1,25D levels shoot up to normal levels before 25(OH)D levels reach 12 ng/ml. They then stay in a normal range no matter how high 25(OH)D levels rise. The kidney is the primary controller of blood 1,25D levels. The normal range is about 16 to 42 pg/ml (42 to 110 pmol/L).

While all human cells can convert 25(OH)D to 1,25D, most cannot release 1,25D into the blood. 25(OH)D freely crosses cell membranes and maintains the same level throughout the body; but 1,25D does not cross membranes. This allows every cell in the body to “personalize” its 1,25D levels to its own needs.

Both 25(OH)D and 1,25D are active ligands for the Vitamin D Receptor (VDR), a nuclear receptor.  [1] When either 25(OH)D or 1,25D binds to the VDR, the compound is imported into the nucleus, where it combines with a vitamin A-activated Retinoid X-Receptor (RXR) to form a transcription factor which, among other roles, upregulates production of antimicrobial peptides (AMPs) that are crucial for cellular defense against intracellular pathogens.

The difference between 25(OH)D and 1,25D is that 1,25D is about fifty-fold more likely to bind to the VDR than 25(OH)D. So by converting more 25(OH)D to 1,25D, cells can upregulate their VDR activation and upregulate their immune defense against pathogens. Meanwhile, uninfected cells can keep their 1,25D levels low. Across human cells, there is a thousand-fold variation in the rate of conversion of 25(OH)D to 1,25D. [1]

In chronic infectious diseases, blood 1,25D is dysregulated

However, in people with chronic infectious diseases, 1,25D levels range all over the map, and are largely uncorrelated with 25(OH)D levels.  Here is a scatter plot from a paper by Dr. Greg Blaney [2]:

The patients in this sample were 100 chronic disease patients: 29 with fibromyalgia, 27 with chronic fatigue syndrome, 12 with post-treatment Lyme Disease, 9 with metabolic disease, 6 with osteoarthritis, 4 with irritable bowel syndrome, 4 with psoriatic arthritis, 3 with multiple sclerosis, 3 with seronegative arthritis, and 27 with other diseases.

Probably all of these diseases are caused by chronic parasitic infections.

A few things to note from this plot: (1) 25OHD levels in a lot of chronic disease patients cluster around the 61 nmol/L level that qualia has; and (2) most chronic disease patients have 1,25D levels well above the normal range, even though their 25OHD levels are mostly below the optimal level in healthy people.

What Causes 1,25D Dysregulation?

Here’s where we get into speculation. There just hasn’t been research exploring this question. Researchers are only just realizing that these diseases are infectious in origin and that vitamin-D-mediated innate immunity is critical to the intracellular immune defense.

Rather than speculate, I’m just going to mention a couple of possibilities.

First, in granulomatous diseases like sarcoidosis, it’s common to have low 25(OH)D and very high 1,25D. Granulomas are nodules where immune cells have been unable to eliminate some foreign matter and instead have built a barrier around it that walls it off from the body.  Granulomas often release 1,25D to the body. Some other granulomatous diseases: 

  • Tuberculosis
  • Leprosy
  • Schistosomiasis
  • Histoplasmosis
  • Cryptococcosis
  • Crohn’s disease

These are all infectious diseases, some of them protozoal in origin.

Second, nearly all human pathogens manufacture proteins or RNA that interfere with the innate immune response. Some are known to interfere with the VDR or with other aspects of vitamin D biology. (The HIV virus blocks the VDR entirely, one reason why it predisposes AIDS patients to infections.) It’s possible that vitamin D dysregulation is brought about by direct pathogen actions to disrupt cellular vitamin D pathways.

Conclusion

The only thing we can conclude with confidence from qualia’s vitamin D tests is that he must have a chronic infectious disease … but he knew that already.

Qualia would be best served by getting advice from an infectious disease specialist with experience in chronic diseases. Such a doctor might be able to narrow down the diagnosis. A diagnosis would help determine which antibiotics might be appropriate to help fight the infection.

Until a doctor’s diagnosis or qualia’s personal experience indicates otherwise, it’s probably prudent to continue with a reasonable intake of vitamin D and to increase iodine as quickly as possible. (Even this is not certain: the standard advice is to minimize vitamin D in granulomatous diseases.) Other infection-fighting supplements, like vitamin C, N-acetylcysteine, and glutathione are likely to be helpful also.

Finally, I always recommend that anyone with a chronic disease find a good discussion forum, like the one at http://cpnhelp.org, and try to find people with similar disease histories and learn from their experiences.

Best of luck, qualia, and please keep us posted.

References

[1] Lou YR et al. 25-Hydroxyvitamin D(3) is an agonistic vitamin D receptor ligand. J Steroid Biochem Mol Biol. 2010 Feb 15;118(3):162-70. http://pmid.us/19944755.

[2] Blaney GP et al. Vitamin D metabolites as clinical markers in autoimmune and chronic disease. Ann N Y Acad Sci. 2009 Sep;1173:384-90. http://pmid.us/19758177.

Why You Shouldn’t Supplement Calcium

Posted by on August 20, 2010 47 comments

Much of the advice handed out by medical doctors is unreliable.  One reason is that the research on which that advice is based is often conducted by specialists who overlook effects beyond their scope of professional interest.

We’ve mentioned previously the example of statin research. Statin studies are generally performed by cardiologists and in the U.S., many statin studies reported only heart attacks and other cardiovascular events as endpoints, not total mortality, cancer, or infectious disease. This method of evaluating drugs would show a lethal neurotoxin to be the best cardiac treatment ever:  In the neurotoxin group not a single patient would die of a heart attack!

A similar myopia has occurred in osteoporosis research, where doctors have focused on the effect of calcium supplements on bone density or fracture rates but often do not evaluate the effect of the supplements on overall health.

But other effects have to be considered, given that:

  • Calcification of coronary arteries may be the best single indicator of heart attack risk. [1]
  • In the Nurse’s Health Study, supplementation of calcium increased the risk of calcium oxalate kidney stones by 20%. [2]
  • Calcium is a strong promoter of biofilm formation in most pathogenic bacterial species. [3] It also likely promotes formation of Candida albicans (fungal) biofilms. As a result, it can aggravate bowel disorders and infectious diseases.

Clearly, calcium in the wrong places – a problem that could be exacerbated by calcium supplementation – is a major health risk.

What causes calcium to go in the wrong places? Deficiencies of vitamin D and vitamin K2 are common reasons. Deficiencies of both are widespread. Vitamin K2 deficiency is a known cause of vascular calcification.

A few years ago, a group of New Zealand researchers conducted a randomized clinical trial that found that over five years, older women taking calcium supplements doubled their risk of heart attack compared to women taking a placebo. [4]

Now, the same group has conducted a systematic review of calcium supplementation studies which confirms the link between calcium supplementation and heart attacks. Dr. Mark Bolland of the University of Auckland, New Zealand, and colleagues report that calcium supplementation increases the risk of heart attack by 31%, the risk of stroke by 20% and the risk of death by 9%. [5]

In an accompanying editorial, Dr. John Cleland writes:

Calcium supplements, given alone, … are ineffective in reducing the risk of fractures and might even increase risk, they might increase the risk of cardiovascular events, and they do not reduce mortality. They seem to be unnecessary in adults with an adequate diet. Given the uncertain benefits of calcium supplements, any level of risk is unwarranted. [6]

We concur. A healthy diet, including dairy and green leafy vegetables, not to mention a daily multivitamin (ours contains 200 mg calcium), should provide a sufficiency of calcium as long as vitamin D levels are normal. If you’re worried about bone health, supplement with vitamins D, K2, and magnesium citrate – not calcium.

[1] Budoff MJ et al. Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol 2007;49:1860-1870. http://pmid.us/17481445. 

[2] Curhan GC et al. Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann Intern Med. 1997 Apr 1;126(7):497-504. http://pmid.us/9092314.

[3] Kierek K, Watnick PI. The Vibrio cholerae O139 O-antigen polysaccharide is essential for Ca2+-dependent biofilm development in sea water. Proc Natl Acad Sci U S A. 2003 Nov 25;100(24):14357-62. http://pmid.us/14614140.  Geesey GG et al. Influence of calcium and other cations on surface adhesion of bacteria and diatoms: a review. Biofouling 2000; 15:195–205.

[4] Bolland MJ et al. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ. 2008 Feb 2;336(7638):262-6. http://pmid.us/18198394.

[5] Bolland MJ et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010 Jul 29;341:c3691. doi: 10.1136/bmj.c3691. http://pmid.us/20671013.

[6] Cleland JG et al. Calcium supplements in people with osteoporosis. BMJ. 2010 Jul 29;341:c3856. http://pmid.us/20671014.

Statin Idiocy

Posted by on August 13, 2010 4 comments

You may have noticed the ludicrous proposal from a group of British doctors, published in the American Journal of Cardiology [1], that statins should be distributed with McDonald’s value meals to reverse the cholesterol-raising effects of cheeseburgers metabolic syndrome induced by sugar and omega-6 fat toxicity.

Various bloggers have discussed their proposal, and if you are interested here are some links:

We rarely discuss drugs, since we’re diet and nutrition focused, but briefly, statins should be avoided because they do a mix of benefits and harms, of which the benefits are minor and can be better achieved by other means, and the harms can be immense:

  • Coenzyme Q10 deficiencies impairing mitochondrial function and producing potentially life-threatening muscle weakness (myopathy).
  • Cholesterol deficiencies impairing cell movement, cell division, and wound healing and increasing risk of infectious disease and cancer.
  • A myriad of other effects, including liver damage, kidney damage, and cataracts.

It appears that the benefits of statins are achieved mainly through two mechanisms – an elevation of vitamin D synthesis and a mild anti-inflammatory effect. (Cholesterol-lowering drugs which lack these effects have proven to be highly poisonous.) Normalizing vitamin D levels through sunshine and supplements would eliminate the first benefit; eating a diet low in food toxins would eliminate the second benefit. So for people practicing healthy diets, there is likely to be no benefit from statins at all, and much harm.

It’s telling that clinical trials conducted since trial regulations were tightened a few years ago have failed to show any benefit from statins. [2] Earlier trials were biased in various ways, including in many cases a failure to report overall mortality or deaths from infectious disease and cancer, and a severe publication bias in which trials producing negative effects were suppressed.

Meanwhile simple, inexpensive steps like supplementation can have much bigger health benefits than statins. Normalizing vitamin D levels can cut mortality in half [3, 4] and supplementing vitamin K2 can reduce mortality by 26%. [5]

So, if we don’t normally discuss drugs, what prompted this post?  My eye was caught by Stephan’s observation that farm subsidy modifications could greatly improve public health:

Rather than giving people statins along with their Big Mac, why don’t we change the incentive structure that artificially favors the Big Mac, french fries and soft drink? If it weren’t for corn, soybean and wheat subsidies, fast food wouldn’t be so cheap. Neither would any other processed food. Fresh, whole food would be price competitive with industrial food, particularly if we applied the grain subsidies to more wholesome foods.

I’ve long advocated this change myself. It’s ironic that the US government managed to pick the most toxic foods – wheat, corn, and soybeans – for its agricultural subsidies. 

It’s often pointed out that U.S. longevity is worse than would be expected based on our GDP. Here’s a chart from gapminder.org – click for a legible version:

If you fit a curve and measure distance beneath the curve, among rich nations only Brunei, Qatar, and maybe Luxembourg and Liechtenstein perform worse than the US. Americans die years earlier than we ought.

The reason for this is probably mainly our agricultural subsidies and the high intake of toxic foods they have engendered. (Our high intake of health-impairing drugs like statins may also contribute.) As I commented on Stephan’s blog:

If we ate rice instead of wheat, butter instead of soybean oil, and drank tea instead of corn syrup, Americans might be the longest-lived people in the world.

Diet and nutrition are the keys to health, yet they are the ugly stepchildren of American medicine. Drugs remain the favored and spoiled son, producing little but beloved.

References

[1] Ferenczi EA et al. Can a Statin Neutralize the Cardiovascular Risk of Unhealthy Dietary Choices? Am J Cardiol. 2010 Aug 15;106(4):587-592. http://pmid.us/20691321.

[2] de Lorgeril M. Disappointing recent cholesterol-lowering drug trials: is it not time for a full reappraisal of the cholesterol theory? World Rev Nutr Diet. 2009;100:80-9. http://pmid.us/19696530.

[3] Dobnig H et al. Independent association of low serum 25-hydroxyvitamin d and 1,25-dihydroxyvitamin d levels with all-cause and cardiovascular mortality. Arch Intern Med. 2008 Jun 23;168(12):1340-9. http://pmid.us/18574092.

[4] Pilz S et al. Vitamin D and mortality in older men and women. Clin Endocrinol (Oxf). 2009 Nov;71(5):666-72. http://pmid.us/19226272.

[5] Geleijnse JM et al. Dietary Intake of Menaquinone Is Associated with a Reduced Risk of Coronary Heart Disease: The Rotterdam Study. J Nutr. 2004 Nov;134(11):3100-5. http://pmid.us/15514282.