- From: <jcannell@charter.net>
- Date: Sat, 24 Jan 2004 20:04:18 -0700
- To: w3c-wai-ua@w3.org
VITAMIN D IN THE NEWS The Vitamin D Newsletter January 24, 2003 The Vitamin D Council 9100 San Gregorio Road Atascadero, CA 93422 805 462-8129 http://www.cholecalciferol-council.com jjcannell@charter.net This is a periodic newsletter concerning vitamin D published by the Vitamin D Council, a non-profit corporation described at the end of this newsletter. Both the content and tone of this newsletter is the product of the Vitamin D Council and not of any of the scientists listed below. Any errors are our responsibility and we encourage readers to alert us to any mistakes. If any critic can find a substantial error in anything we have printed, we will bring that error to the attention of our readers, correct it, and confer a free lifetime subscription to the Newsletter upon the critic. We are particularly interested in not overstating our case. All we are asking is for the medical establishment to listen to what the vitamin D scientists are saying: vitamin D deficiency is widespread and that deficiency appears to play a significant role (the extent currently undetermined) in many of the multifactorial chronic diseases that afflict modern society. You are on the our mailing list because you: have a research interest, a general academic interest or a clinical interest in vitamin D; are a research scientist, a professional health or science writer, a health care provider; or an employee or associate of the NIH, CDC or the National Academies. You have been selected to receive this publication free for the near future. To unsubscribe from The Vitamin D Council Newsletter, just click on the following link and follow instructions: http://www.cholecalciferol-council.com/cgi-bin/dada/mail.cgi VITAMIN D IS IN THE NEWS. CONSIDER TODAY’S INDEPENDENT NEWSPAPER, ONE OF THE BIGGEST NEWSPAPERS IN THE UK. http://news.independent.co.uk/uk/health/story.jsp?story=483268 IN THE LAST SEVERAL YEARS, MAINSTREAM SCIENTISTS AT MAJOR UNIVERSITIES HAVE REPORTED AN INCREDIBLE VARIETY OF ILLNESSES ARE ASSOCIATED WITH INADEQUATE VITAMIN D INTAKE. CONSIDER THE FOLLOWING STORIES REPORTED BY WEBMD. VITAMIN D MAY PREVENT MS http://my.webmd.com/content/article/79/96225.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d VITAMIN D MAY PREVENT ARTHRITIS http://my.webmd.com/content/article/79/96161.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d VITAMIN D HAS HEART BENEFITS http://my.webmd.com/content/article/19/1689_52736.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d LACK OF VITAMIN D LINKED TO PAIN http://my.webmd.com/content/article/78/95751.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d DON'T LET VITAMIN D LEVEL DIP IF YOU HAVE BOWEL DISEASE http://my.webmd.com/content/article/23/1728_56741.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d VITAMIN D SUPPLEMENTS MAY PROTECT AGAINST DIABETES IN KIDS http://my.webmd.com/content/article/35/1728_92680.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d COULD TOO LITTLE VITAMIN D CAUSE CANCER? http://my.webmd.com/content/article/77/95337.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d VITAMIN D AND HYPERPARATHYROIDISM http://my.webmd.com/content/article/22/1728_56216.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d VITAMIN D KEY TO COLON CANCER http://my.webmd.com/content/article/16/1671_53266.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d VITAMIN D PREVENTS TOOTH LOSS http://my.webmd.com/content/article/28/1728_61745.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d VITAMIN D MAY ALLOW FOR LOWER DOSES OF STEROIDS http://my.webmd.com/content/article/22/1728_55456.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d Everything from chronic pain, to diabetes, arthritis, bowel disease, multiple sclerosis, cancer and tooth loss! Of course there are even more conditions associated with vitamin D deficiency as readers of this newsletter know. The problem is that other than osteoporosis, osteomalacia and rickets, the quality of the causation evidence varies from little to suggestive. However, one thing most Americans seem to believe is that sunlight must be avoided for it causes skin cancer, especially malignant melanoma. We decided to give a little quiz about the subject. 1. Imagine that Andrew C. von Eschenbach, M.D., the director of the National Cancer Institute (NCI), visited his dermatologist who examined him and diagnosed a small squamous cell cancer on his nose. His dermatologist, who noted that Dr. von Eschenbach had the quaint custom of regularly exposing his body to short courses of noonday sunlight on the roof of the National Library of Medicine, advised Dr. von Eschenbach to now totally avoid the sun. As Dr. von Eschenbach has read every scientific article ever written on cancer, his reaction was: A. He thanked his dermatologist but knowing the prognosis is grim for those who develop squamous cell skin cancers, went home and wrote a will. B. He immediately arranged to have a complete examination by an internist as Dr. von Eschenbach knows his chances of developing internal squamous cell cancers is much higher after being diagnosed with a squamous cell skin cancer. C. He knew he must now avoid the sun entirely, so he bought cases of sunblock and lots of clothes that would totally protect his skin. He vowed to never let another ultraviolet ray of sunlight ever strike his unprotected skin. D. He jumped up, smiled broadly, hugged his dermatologist, arranged to have the skin cancer removed, put some unblock on his face and hands, took of his shirt and changed into shorts for the walk to his car and then drove home to tell his loved ones the good news. The correct answer is D. Dr. von Eschenbach knows that virtually all squamous cell skin cancers are easily treated when caught early and that fewer than 600 Americans die every year from squamous cell skin cancers compared to tens of thousands who may be dying from internal malignancies induced by vitamin D deficiency. Furthermore, he knows the strong inverse relationship between squamous cell skin cancers and the subsequent development of internal cancers has been known more than sixty years. He also knows that inverse relationship led to one of the first modern theories of cancer (that squamous cell skin cancers conferred immunity against various visceral cancers) which is better explained by sun exposure increasing both squamous cell skin cancers and calcidiol levels. Furthermore, he knows that the inverse association between sun-exposure and several common internal malignancies is robust and has been documented repeatedly. Furthermore, he knows that one of the best things he can do to reduce his chance of getting up to 13 different serious internal cancers is to continue to maintain his healthful levels of serum calcidiol [25(OH) D] by consistent safe sun exposure. If he preferred to totally avoid the sun and oily fish, relying on vitamin D supplements instead, he would need to take between 3,000 to 5,000 IU of cholecalciferol a day to maintain a 25 (OH)D level above 40 ng/ml. References: Apperly FL. The relation of solar radiation to cancer mortality in North America. Cancer Res 1941; 1:191-5 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2263572&dopt=Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1536921&dopt=Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7721513&dopt=Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1451068&dopt=Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10350434&dopt=Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2572900&dopt=Abstract 2. The latest evidence suggests 21,000 Americans die every year from internal malignancies associated with inadequate UVB exposure? A. True B. False True. Actually Grant feels the number below is an underestimate and is coming out with an even more frightening estimate. References: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11920550&dopt=Abstract 3. As malignant melanoma is caused by chronic sun exposure, the incidence of malignant melanoma is more common on the hands, is more common in those who work outdoors and is less common in those who use sunscreen. A. True B. False False. Although malignant melanoma does increase with age, the increase is not dramatic as it is with the skin cancer most clearly associated with chronic sun-exposure, squamous cell skin cancer. And, unlike squamous cell carcinoma, malignant melanoma is most common on relatively less exposed areas (backs in men and upper legs in women), is less common in outdoor workers than indoor ones and evidence to date does not show regular sunscreen use reduces its incidence. Instead of being caused by chronic sun-exposure, malignant melanoma is a multifactorial disease, the sun-exposure component of which appears to be best explained by repeated intermittent intense exposure (sunburn) in a population that usually avoids the sun (vitamin D deficient population). References: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9766557&dopt=Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10699940&dopt=Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3179192&dopt=Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3988369&dopt=Abstract 4. For many years, the regular use of sunblock may have actually increased the incidence of melanoma? A. True B. False True. Until a few years ago, sunblock usually blocked the burning (and vitamin D producing) UVB while allowing the more deeply penetrating, UVA. Thus, they may have contributed to the rising incidence of malignant melanoma by allowing users to stay in the sun for hours without burning, while their skin soaked up the highly penetrating UVA radiation. The best sunlight recommendations to prevent malignant melanoma may turn out to be to regularly expose your entire unsunblocked skin to very short periods (1/3 the time it takes for your skin to begin to redden) of direct noonday sunlight during the correct season of the year being careful to never let your skin get red or burn. References: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14678916&dopt=Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9335442&dopt=Abstract 5. Pretend that Kenneth, Director of the National Institute of Environmental Health Sciences, was asked if the American Academy of Dermatology (AAD) recommendations to totally avoid sunlight may have helped cause the rising incidence of melanoma and other diseases over the last 20 years by contributing to the current pandemic of vitamin D deficiency. What should his answer be? A. Yes B. No Yes. The American Academy of Dermatology press releases and spokesmen (http://www.aad.org/PressReleases/VitD_Sunshine.html) are particularly misinformed about vitamin D and appear to be giving information that increase the risks of developing a multitude of vitamin D deficiency related illness (including hypertension, heart disease, cancer, autoimmune disease, diabetes, depression, and, perhaps, even malignant melanoma). Raymond L. Cornelison Jr., MD, President of the American Academy of Dermatology said, “ People who practice proper sun protection and are concerned that they are not getting enough vitamin D should either take a multivitamin or drink a few glasses of vitamin D fortified milk every day. The dangers of exposing oneself to carcinogenic UV light from the sun, even for a few minutes, are firmly established, particularly since dietary intake of vitamin D can completely and easily fulfill our needs.” Dr. Cornelison and the AAD are putting their member dermatologists at risk for future malpractice liability with such incompetent advice. When dermatologists assume control of the vitamin D system by recommending their patients terminate sun-exposure, they are required to ensure their patients have an adequate vitamin D status and that can only be assured by 25(OH) D (calcidiol) levels. Dr. Cornelison seems to be unaware that diet, without sunlight, can rarely supply adequate vitamin D and that one multivitamin (400 IU of vitamin D) a day, without sunlight, will actually ensure vitamin D deficiency. Just like an anesthesiologist, who assumes responsibility the airway on the patient she intubates, dermatologists who tell patients to totally avoid the sun, assume responsibility for their patient’s vitamin D system. A number of academic dermatologists have said just that. See if you can pick out the following quote in the two references listed below: “it would seem mandatory to ensure an adequate vitamin D3 status if sun exposure were seriously curtailed, certainly in relation to carcinoma of breast, prostate and colon and probably also malignant melanoma.” Coming from an academic dermatology center, it sounds like the kind of statement that juries take into account when trying to decide the applicable Standards of Care. References: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12174089&dopt=Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12720576&dopt=Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12520530&dopt=Abstract Humans evolved naked in the sun and have lived most of our time on earth within 30 degrees of the equator. Clothes are a recent addition, as are the vitamin D reducing effects of cities, indoor work, automobiles and sunblock. We will ask one more question. The majority of Americans have 25(OH)D (calcidiol) levels most similar to which of the following groups: A. Old World, non-human primates living in the wild. B. New World non-human primates living in the wild. C. Modern day agricultural humans living near the equator. D. Modern day humans spending some of their time in a natural state (lifeguards). E. Lab rats. You guessed it! THE VITAMIN D SCIENTISTS LISTED BELOW ARE WRITING AND SPEAKING OUT ABOUT THE PROBLEM OF VITAMIN D DEFICIENCY. ALL ARE WILLING TO SPEAK WITH THE PRESS. NONE ARE MEMBERS OF THE VITAMIN D COUNCIL. William Grant, PhD (Epidemiology) 12 Sir Francis Wyatt Place Newport News, VA 23606-3660 Phone: (757) 599-9811 Email: wbgrant@infionline.net Robert Heaney, MD Osteoporosis Research Center Department of Medicine Creighton University Medical Center Omaha, NE 68131 Phone: (402) 280-4029 Email: rheaney@creighton.edu Michael Holick, PhD, MD Vitamin D Laboratory Department of Medicine Boston University Medical Center 715 Albany St. M-1022 Boston, MA 02118 Phone (617) 638-4545 Fax 617-638-8882 Email: mfholick@bu.edu Bruce Hollis, PhD Departments of Pediatrics Medical University of South Carolina 171 Ashley Ave. Charleston, SC 29425 Phone (843) 792-6854 Fax (843)792-8801 Email: Hollisb@musc.edu Christel Lamberg-Allardt, PhD University of Helsinki, Department of Applied Chemistry and Microbiology P.O.Box 27, FIN-00014 University of Helsinki Finland Phone: (358) 9-1-915-8266 Fax: (358) 9-1-915-8475 Email: christel.lamberg-allardt@helsinki.fi Tony Norman, PhD Department of Biochemistry Room 5456 Boyce Hall University of California Riverside, CA 92521 Phone: (909) 787-4777 Fax: (909) 787-4784 Email: anthony.norman@ucr.edu Reinhold Vieth, PhD Pathology and Laboratory Medicine Mount Sinai Hospital 600 University Ave. Toronto, Ontario, Canada, M5G 1X5 Phone (416) 586-5920 Fax (416) 586-8628 Email: rvieth@mtsinai.on.ca ABOUT VITAMIN D: Vitamin D is a vital nutrient that is unique, both in terms of its physiology and because humans rely on both endogenous skin production and exogenous sources to meet biological requirements. Vitamin D is commercially available as vitamin D2, (ergocalciferol) made from plant products, and vitamin D3, (cholecalciferol) made from animal products. Cholecalciferol is also made naturally in the skin by the action of a specific wavelength of ultraviolet light (UVB) interacting with precholesterol. Cholecalciferol is then transported to the liver and turned into calcidiol [(25-hydroxyvitamin D]. Recent evidence indicates calcidiol [(25-hydroxyvitamin D] has steroid hormone functionality. In turn, the calcidiol [25-hydroxyvitamin D] is transported to the kidney and transformed into a more potent steroid, calcitriol [1,25-dihydroxyvitamin D], which is excreted into the blood to help regulate calcium in the body. This is the main endocrine function of vitamin D. Meanwhile, many tissues other than the kidney turn calcidiol [25-hydroxyvitamin D] into calcitriol [1,25-dihydroxyvitamin D]. Calcitriol [1,25-dihydroxyvitamin D], and perhaps calcidiol [25-hydroxyvitamin D], help regulate gene expression locally; this is the newly discovered autocrine (inside the cell) and paracrine (surrounding the cell) functions of vitamin D. This autocrine and paracrine function is impaired in vitamin D deficient subjects. All studies show many Americans are vitamin D deficient, especially Blacks, where the problem is pandemic. This use of calcitriol (and perhaps calcidiol) by other tissues as an autocrine and paracrine hormone is a relatively new discovery that explains its role in human development as well as the many health benefits of vitamin D in other illnesses such as diabetes, hypertension, heart disease, autoimmune illness, at least 13 different cancers and, perhaps, some mental illness. The single most important scientific fact about vitamin D is that young adult Whites make about twenty thousand units of cholecalciferol in their skin within minutes of whole-body, summer-sun exposure. This is one-hundred times the Adequate Intake (AI) and five times the toxicity maximums (Lowest Observed Adverse Effects Level or LOAEL) recommended by the Institute of Medicine (IOM) for young adults. Therefore, many Americans greatly exceed the IOM’s safety recommendations by simply spending a few minutes outside in their swimming suits! This extraordinary rate of natural vitamin D production in the skin(20,000 IU) leading to the production of potent endocrine, paracrine and autocrine steroid hormones leads one (as T.S. Eliot once said), “to an overwhelming question.” Why did Nature design such a complex steroid system reliant on rapid and bountiful production of cholecalciferol in the skin? Answer,” Probably for a very good reason.” Because low calcidiol [25-hydroxyvitamin D] levels (< 35 ng/ml) are associated with so many chronic illnesses, calcidiol [25-hydroxyvitamin D] levels are an important part of any laboratory health evaluation and should be routinely checked by physicians. Holick recommends they be checked every year, preferably in the fall. We recommend they be obtained twice a year, once in late October and again in early April, depending on latitude, in order to obtain both peak and valley levels. Unfortunately, few physicians are aware of the vitamin D deficiency pandemic, so virtually no patients have their levels checked. Consequently, perhaps as many as 70% of the U.S. population has calcidiol [25-hydroxyvitamin D] levels below 35 ng/ml. Even when asked to check vitamin D levels, physicians often order calcitriol [1,25-dihydroxyvitamin D] levels, instead of calcidiol [25-hydroxyvitamin D] levels, an error which greatly misleads both the physician and the patient. For numerous reasons (optimal calcium absorption, maximal suppression of PTH, reduction in blood pressure, decreased incidence of various cancers, retarding the progression of osteoarthritis, reducing sarcopenia (muscle wasting), reducing the incidence of autoimmune illness, reduction in CRP, etc), healthful blood levels of calcidiol [25-hydroxyvitamin D] are between 35 and 55ng/ml although commercial labs usually report “normal” or Gaussian distributions of between 8-72 ng/ml depending on the latitude of the lab’s population. Therefore, commercial reference laboratories also mislead physicians and their patients by reporting “normal” (Gaussian) distributions of a deficient population instead of healthful calcidiol [25-hydroxyvitamin D] levels. Patients need to know these facts before asking their physician for the calcidiol [25-hydroxyvitamin D] blood test. Until the medical profession becomes knowledgeable on this matter, patients need to become educated, educate their physicians, get the proper blood test and then take steps to raise their calcidiol [25-hydroxyvitamin D] level if it is less than 35 ng/ml. We know of no good reason to exceed 50ng/ml. Documented toxicity may start at around 80 ng/ml (200 nm/L), but that would require chronic sustained input from all sources of more than 20,000 IU per day. Populations around the equator (where man evolved) and groups spending time outdoors without many clothes (lifeguards), have levels of around 50ng/ml. Such observations have important implications for the vitamin D conditions under which humans evolved. In other words, it suggests humans have had 25-hydroxyvitamin D levels of around 50 ng/ml for 99.99 % of the time they have been on earth. Only in the last several hundred years has urbanization, industrialization, glass (UVB does not penetrate glass), excessive clothes (UVB does not penetrate clothes), sunblock and medical advice to completely avoid sunlight lowered 25-hydroxyvitamin D levels to their currently deficient levels. Persons with low levels have three choices: the sun, a low-pressure sunlamp or vitamin D supplements. One cannot obtain adequate vitamin D from food unless one regularly eats very large quantities of oily fish. Milk is supposed to have 100 IU of vitamin D a glass but often contains less. Contrary to popular belief, most other dairy products have none. At most latitudes in the USA, little or no vitamin D is made in the skin in the late fall and early winter. In northern states, the vitamin D blackout lasts for almost six months. In the spring and summer, young Whites can make large amounts (20,000 IU) by sunbathing on both sides, without sunblock, for a few minutes (about 1/2 the time it takes for the skin to begin to slightly redden). UVB meters can be most helpful in determining if there is sufficient UVB in the sunlight at your latitude, season and time of day, (http://www.solarmeter.com/model6.html). Older person need longer exposure and do not have the robust abilities of the young but can still make 8,000 IU in a single full body exposure. Darker skinned persons need 5 to 10 times longer depending on the amount of melanin pigment in the skin. Vitamin D production occurs within minutes and is maximized long before the skin turns red or begins to tan. One does not have to worry about toxicity or get repeated blood tests when using sun exposure to obtain vitamin D. Toxicity cannot occur even with heavy and continuous sunbathing because ultraviolet light begins to degrade vitamin D in the skin after making about 20,000 IU, thus reaching sated state. Overexposure, especially sunburns, is damaging to the skin, dangerous, and should be entirely avoided. Some artificial low-pressure sun lamps contain significant amounts of UVB and raise calcidiol [25-hydroxyvitamin D] levels into the healthful range. Just like the sun, one does not have to worry about toxicity or obtain repeated blood levels, when using them. However, just like the sun, care must be taken not to overexpose the skin. Suntans are not needed to obtain adequate vitamin D. Sunburns must be avoided. One manufacturer with some vitamin D data is Sperti: http://www.sperti.com/products.htm. Many people are beginning to rely on supplements to raise their calcidiol [25-hydroxyvitamin D] levels as they have been told (usually erroneously) to entirely avoid any sunlight. (Totally avoiding the sun and supplementing with vitamin D assumes that the only benefit of sunlight is vitamin D, which is a premature and potentially dangerous assumption). In the complete absence of UVB, one must consume 3,000 to 5,000 IU of cholecalciferol a day to maintain healthful calcidiol [25-hydroxyvitamin D] levels. Similar studies have not been done with ergocalciferol but current data indicates that almost twice as much ergocalciferol would be needed. Vitamin D repletion is safest when done under a physician’s care so calcidiol [25-hydroxyvitaminD] levels (and perhaps calcium levels) can be monitored. Persons diagnosed with sarcoidosis, other granulomatous disease, cancer (especially lymphoma) or hyperparathyroidism should not take vitamin D unless they are under the care of a knowledgeable physician (and would be well advised to find one). Patients with these conditions may develop a vitamin D hypersensitivity syndrome, which is different from vitamin D toxicity. Persons who do not want to have blood tests would be best advised to rely on prudent sun exposure. If such persons choose to avoid the sun, they should never exceed 2,000 IU of cholecalciferol a day [which is the Institute of Medicine’s NOAEL (No Observed Adverse Effects Level)]. Cholecalciferol can be obtained at health food stores and on the internet. Ergocalciferol can be obtained in 25,000 and 50,000 IU doses via prescription from your doctor. We obtain pharmaceutical grade 1,000 IU capsules of cholecalciferol made by Roche from the Life Extension Foundation: (http://www.lef.org/newshop/items/item00251.html). Cod liver oil contains about 1200 IU of vitamin D per tablespoon but also may contain about 14,000 IU of vitamin. Therefore, persons with no sun exposure may exceed safe intakes of vitamin A in order to replete the vitamin D system. (We know omega-3 nutrition is very important but believe fish oil to be a safer alternative than cod liver oil). Vitamin D can be toxic in overdose (more than 40,000 IU a day over several months). Virtually all the toxicity reports in the literature are iatrogenic: large doses of ergocalciferol prescribed for medical reasons (usually hypoparathyroidism or osteoporosis). We are not aware of any reports in the literature of deaths from acute overdose, such as murder or suicide. In fact, a 150-pound human would have to take more than 100,000 capsules of the 1,000 IU cholecalciferol capsules to approach the LD50 for the most sensitive mammal (the male rat at 40 mg/kg). Such patients would be more likely to die from gastric bloating leading to asphyxiation than from vitamin D toxicity. In mammals, signs of toxicity short of death can first be seen at.5mg/kg (20,000 IU/kg or 1,400 capsules at one time for a 150-pound adult human). We are unaware of any reports of vitamin D toxicity from cholecalciferol supplements except when manufacturing errors occurred. Most of the reported toxicity is industrial (dairies putting in the wrong amount into milk or the concentrated oil being used for cooking). However, death from chronic poisoning has been described and is possible. If you believe “a little is good then a whole lot is better,” then you may prove an association between judgment and Natural Selection. LEGAL ASPECTS: To date, we know of no physician who has had a malpractice action filed against him for failure to diagnose or treat vitamin D deficiency. We are not aware of a single dermatologist held liable for telling a patient to totally avoid the sun (without taking care to monitor their calcidiol [25(OH)D] levels), no matter how many vitamin D deficiency associated diseases that patient subsequently develops. However, commercial reference labs that mislead physicians with outdated “normal” distribution levels (Gaussian distributions of deficient populations), instead of healthful or ideal calcidiol [(25(OH)D] levels, do have obvious liability exposure as do dermatologists who assume control of the vitamin D system via their sun-abstinence advice. The Vitamin D Council has attempted to educate, via registered letter, the American Board of Pathology as well as the five largest commercial reference labs in the USA about the danger of misleading 25(OH)D reporting methods and the damage those misleading reports may engender. We plan additional such educational activities directed at the American Academy of Dermatology. Things change quickly in tort law; as soon as readers know of any vitamin D cases, we would like to hear about them. Current medical journals are full of dire warnings by the top experts. As unfair as such suits would seem to practicing physicians, we believe continued suffering from undiagnosed and untreated vitamin D deficiency is more unfair. The Vitamin D Council feels malpractice suits are inevitable and, no matter how disquieting, will herald the end to death and disability due to undiagnosed and untreated vitamin D deficiency. Remember, losing a malpractice case requires that only a preponderance of evidence (51%) was against you, not proof beyond a reasonable doubt. Scientific proof is not required, only opinions by medical experts that meet the legal (Daubert) standards for experts. Some physicians also mistakenly think standard care is the same as Standard of Care; they are not and never have been. Standard care is what most doctors do, Standard of Care is what one jury thought one physician should have done with one patient at particular time in one particular jurisdiction. Most importantly, Standards of Care are never determined by the Institute of Medicine, the Food and Nutrition Board, the National Institute of Health, the American Medical Association, practice guidelines, your supervisor, your Chief of Staff, your colleagues or this publication. Standards of Care are only determined by triers of fact (judges or juries) after listening to testimony of experts whose credentials are vetted by the court. ABOUT THE VITAMIN D COUNCIL: The Vitamin D Council is a group of citizens concerned about vitamin D deficiency and the diseases associated with that deficiency. We have recently changed our name from The Cholecalciferol Council to the Vitamin D Council. The Vitamin D Council will attempt to draw attention to the problem of vitamin D deficiency through the education of professionals, the media, government officials and average citizens. Our immediate goal is to fund our non-profit corporation. The Vitamin D Council’s long-range goal is to end the needless suffering and death from vitamin D deficiency. Our initial campaign will center on enabling the Institute of Medicine’s Food and Nutrition Board to reconvene an expert panel on vitamin D nutrition so they can update their recommendations on vitamin D to make it current with today’s science. We also hope to secure a grant to allow us to publish an academic journal on Vitamin D, contracting with one the scientists below to serve as executive editor and others to serve as associate editors. We would then offer subscriptions to the academic community, including readers of this newsletter. However, the Vitamin newsletter you are currently reading will remain separate from the proposed academic journal and will remain free for the foreseeable future. The Vitamin D Council is a nonprofit entity incorporated under the laws of California under the name Cholecalciferol Council. We are a now a tax-exempt, non-profit[501(c)(3)] educational organization under the laws the United States. We currently have no funding but will soon apply for grants as our [501(c)(3)] status was recently granted. We will not accept donations or grants from individuals or organizations whose goals may conflict with ours. Particularly, we will not accept any donations from the American Trial Lawyers Association or groups that represent them. The president of the Vitamin D Council is John Jacob Cannell, MD, the vice-president is Tatiana Cannell, MD, the secretary is Olga Cebanova, MD, MD, and the treasurer is Andrei Gutsu, MD. -- To unsubscribe from: The Vitamin D Council, just follow this link: http://cholecalciferol-council.com/cgi-bin/dada/mail.cgi?f=u&l=cclist&e=w3c-wai-ua@w3.org&p=4871906 Click this link, or copy and paste the address into your browser.
Received on Wednesday, 28 January 2004 14:48:26 UTC