April 29, 2007
60% Cancer Drop From Vitamin D Supplements
As regular readers know, I've been after you for years to raise your body vitamin D levels. If you haven't gotten off your duff yet to do anything about it how about this as something to get you going? A study coming out in June will report a more than halving of the incidence of cancer by taking vitamin D supplements.
But perhaps the biggest bombshell about vitamin D's effects is about to go off. In June, U.S. researchers will announce the first direct link between cancer prevention and the sunshine vitamin. Their results are nothing short of astounding.
A four-year clinical trial involving 1,200 women found those taking the vitamin had about a 60-per-cent reduction in cancer incidence, compared with those who didn't take it, a drop so large — twice the impact on cancer attributed to smoking — it almost looks like a typographical error.
How many people have doctors killed by advocating the avoidance of sun due to the risk of skin cancer?
How much would life expectancies rise if everyone got enough vitamin D?
One of the researchers who made the discovery, professor of medicine Robert Heaney of Creighton University in Nebraska, says vitamin D deficiency is showing up in so many illnesses besides cancer that nearly all disease figures in Canada and the U.S. will need to be re-evaluated. "We don't really know what the status of chronic disease is in the North American population," he said, "until we normalize vitamin D status."
Vitamin D could buy us some extra years while we try to stay alive waiting for rejuvenation therapies.
People are especially deficient during the winter.
Last month, a study of 7,500 men and women found that most don't have enough vitamin D in their bloodstream for at least six months of the year.
'By Easter, 90 per cent of the population are seriously depleted in the amount of vitamin D they have in their bodies,' says author of the study Dr Elina Hypponnen, of the Institute of Child Health in London.
As we get older and our skin ages it becomes less efficient at using light to catalyze the synthesis of vitamin D. So part of the rise in incidence of vitamin D with age is probably caused by worsening vitamin D deficiency.
Vitamin D might do what Linus Pauling claimed vitamin C could do: reduce the incidence of infections.
The malign consequences have been revealed by in a study from the United States which shows that boosting vitamin D may be the most effective way of warding off infections that cause winter colds.
The authors, from Winthrop University Hospital, Mineola, New York, who publish their findings in the journal Epidemiology and Infection, say vitamin D stimulates "innate immunity" by activating peptides in the body that attack bacteria, fungi and viruses.
"Vitamin D supplementation, particularly with higher doses, may protect against the typical winter cold and flu ... Since there is an epidemic of vitamin D insufficiency in the US, the public health impact of this observation could be great," they write.
Vitamin D deficiency is also linked to a higher incidence of auto-immune diseases. For example, multiple sclerosis occurs at higher rates in the more northern regions of North America where people get less sun in the winter due to both cold and shorter days.
The current max recommended limit of 2000 IU per day might be too low.
Calls to increase vitamin D intake have been growing. Indeed, only recently fifteen experts from universities, research institutes, and university hospitals around the world called for international agencies to "reassess as a matter of high priority" dietary recommendations for vitamin D because current advice is outdated and puts the public at risk of deficiency (The American Journal of Clinical Nutrition, Vol. 85, pp. 860-868).
A recent review of the science reported that the tolerable upper intake level for oral vitamin D3 should be increased five-fold, from the current tolerable upper intake level (UL) in Europe and the US of 2000 International Units (IU), equivalent to 50 micrograms per day, to 10,000 IU (250 micrograms per day).
I would suggest refraining from doses above 2000 IU, at least for now. Vitamin D research has become such a hot topic that we should expect more clarification on the risks and benefits of higher doses. But my guess from what I've read so far is that a 2000 IU dose daily is enough to provide the vast majority of the benefit.
Also see some of my previous posts on vitamin D: Vitamin D Could Decrease Overall Cancer Risk 30%, Higher Vitamin D Reduces Aging Bone Fracture Risks, Vitamin D Reduces Breast Cancer Risk, Vitamin D Crucial For Long Term Lung Health, and Vitamin D Confirmed To Reduce Multiple Sclerosis Risk.
The research and the researchers behind these recent press releases and reports seem credible and dedicated, while merely conventional disbelief and a**-covering seems to follow.
This issue should be followed over the next weeks. This may be the 'scurvy of our age'.
How many did doctors kill with sun avoidance advice? Almost nil. Patients are non-compliant by nature. We can't even get them to wear sufficient sunscreen, let alone keep them out of the sun.
The deeper problem is, depending on who you talk to, that Western lifestyle takes you out of the sun by its very nature. When the sun is shining one is indoors...
The RDA is one of those useless measures that should have been retired decades ago. It's like the almost useless BMI that isn't age-adjusted.
So, since most don't supplement with Vit D3 anyways, I strongly suggest getting the 2000 IU, and remembering that D3 is fat-soluble, don't jump to the higher loads. In time, with what is stored in the fat, you will reach your own physiological norm for D3 levels.
Interestingly, this isn't the first time this has been suggested. We've known for quite a time that cancer rates drop as you move towards the equator and it paralells very nicely overall sun exposure.
There are some complaints of sample size, the trial not being prospective randomized, and some complaints that at such a impact we should have seen it in the epidemiologic data previously as a major confounding factor. I think all these complaints are off-base. The value of the study, even if not p-r, stands on its own. Given what we know of vit D, the Bayesian in me gives it all one big thumbs up.
Plus the long-term downside of vit D3 supplementation is nil at 2000-4000 IU.
People should not be afraid to take doses of vitamin D in a higher range than the RDA. I have been reading an interesting heath blog by a cardiologist in Wisconsin, a Dr. Davis http://heartscanblog.blogspot.com/. He uses vitamin D to improve blood lipid markers. The interesting thing is that he measures vitamin D levels in his patients. He says that with the RDA amount of 400 units daily, there is no measureable change in blood levels of 25-OH-vitamin D. He recommends 3000 units daily for men, 2000 daily for women, in an oil based capsule (he says he gets no increase in blood levels using dry forms of vitamin D). This yields a safe and effective blood level of about 50 ng/dl in 80-90 percent of his patients.
Randall did you come across which cancers were included in the 60% drop?, the research is strongest in colorectal, breast, prostate and ovarian cancer. Also, what is more then just getting more Vitamin D through the sun or diet is to get Vitamin biomarkers tested. Research has shown that serum levels of the 25(0H) metabolite is suffienct for cancer protection. As with anything there are downsides to increases in Vitamin D, just today I was reading an article about increases in brain lesions as a result of high vitamin d intake. Elderly men and women who consumed higher levels of calcium and vitamin D are significantly more likely to have greater volumes of brain lesions, regions of damage that can increase risk of cognitive impairment, dementia, depression and stroke. So we needs to balance the pros of vitamin d intakes with its cons. Also, I don't think raising the UL to 10,000 IU would be safe, I have seen first hand the toxic effects at those levels including hypercalcemia, hypercalciuria, or nephrocalcinosis with renal failure. Finally, Randall have you looked into genetic differences in vitamin d receptor sites (VDR)? Due to these varations not all people will respond the same way to vitamin d supplementation. Gene therapies may be needed for the percentage of the population that can't properly utilize the 1,25(OH) metabolite.
Maybe you should pick up a few years supply of vitamins now….
“A new FDA "guidance" document, published on the FDA's website, reveals plans to reclassify virtually all vitamins, supplements, herbs and even vegetable juices as FDA-regulated drugs.”
These results are not consistent with the bulk of knowledge. Also I am very wary when a lot of statistical analysis is done on data. It's almost always wrong. Withold judgement until it is replicated or additional data shows up.
I have been interacting with nutrionists on and off for 25 years and have less than a handful of reports on vit D toxicity. While I concur that such toxicity can occur, it really is rare even at the higher IU dosages. Most toxicity reports also turn out to be in folks that had intakes in the milligram range daily as opposed to 25 to 250 micrograms.
Having said that, 30 minutes sun exposure generates a whopping 10,000-50,000 IU units. Quoting my old alma mater: "Professor Michael Holick of Boston University School of Medicine has studied this extensively and believes a reasonable average of all the studies is 20,000 units." And you don't suffer toxicity...
So, girls and boys, get 30 minutes of sun exposure on your arms (go sleeveless), several times a week, and you will be well on top of the RDA and almost approaching 1,000 to 2,000 units.
rsilvetz, I am not sure what result you are refering to, one thing I left out by mistake was the serum level, I meant to put 30 ng/mL of 25(OH), sorry about that. Again, what research are you citing when you claim you are wary of statistical analysis overkill. Randall has put up info on a study that we know nothing of the analysis that was done, I for one am skeptical of any claim, until I have read the complete study, looked at the design and methods used and the analysis which was performed, most people want a nice little number like 60%, but its not as simple as that. If you want to can send you a reference list of a presentation I recently did on Vitamin D and Cancer, then you can go directly to the research I am basing my claims on.
I have worked for the USDA, Tufts U. and UCLA to name a few, and while working at these places I again have to say I first hand have experienced numerous cases of Vit D toxicty at chronic oral intakes of 10,000 IU and above. In terms of sun exposure, I would like to see the research you are refering to for your claim of 10,000 to 50,000 IU from 30 minutes of sun exposure. As you may or may not know, toxicity of Vitamin D is not a concern from sun exposure.
Vitamin D can be formed in fatty glands in the skin from 7-Dehydrocholesterol. 7-Dehydrocholesterol secreted into the surface of the skin and reabsorbed into various layers of the skin. Each time our skin is exposed to sunlight some of the 7-Dehydrocholesterol is converted to pre-Vitamin D3 (precalciferol), which is thermally isomerizes within a few days to Vitamin D3 (cholecalciferol). Cholecalciferol then diffuses into the blood and binds to a Vit D binding protein (DBP) which is synthesized in the liver. Both7-Dehydrocholesterol and precalciferol can be converted with further UV exposure to inactive metabolites Lumosterol and Tachysterol, respectively. These metabolites along with precalciferol do not possess Vit D activity, do not diffuse out of the skin and, therefore, do not bond to DBP. They remain within the layers of skin and are sloughed off as a result of normal turnover of skin cell. This process protects us from Vit D toxicity due to excessive UV exposure.
For a first cut on current thinking for vitamins, I usually use the "health notes" database available on several supplement manufacturers' websites (the link for the one at puritan's pride is here). You can get to this statement by going to vitamin guide and on to vitamin D:
"Some researchers believe that amounts up to 10,000 IU per day are safe for the average healthy adult, although adverse effects may occur even at lower levels among people with hypersensitivity to vitamin D (e.g. hyperparathyroidism).19 In fact, of all published cases of vitamin D toxicity for which a vitamin D amount is known, only one occurred at a level of intake under 40,000 IU per day.20"
The reference cited is from 1999, so it's possible that it's out of date. Do you know of any published reports of toxicity at 10,000 IUs and above? The statement above, though a bit dated, makes me feel pretty safe with supplementing at the 1,000 to 2,000 IU level.
dbfair, I want to be clear that I support and increase in current intakes of vitamin D espically for people in the northern tier of the country. I personally take 1,000 IU of Vitamin D daily and have my serum levels checked annually. That is the point that I was trying to emphasis, we need to look at the levels of biomarkers for vitamin D for optimal intake, not a certain oral dosage. Everyone is going to react different to each and every nutrient, so a one size fits all appoach just doesn't work. The benefits of testing and though supplementation, maintaining serum levels of Vitamin D above 30 ng/mL is a cost effective approach to cancer prevention. That being said we need to make sure we get just enough Vitamin D for its benefits and no more. While a nutrient may be benifical for one things such as vitamin d and colon cancer is can be harmful as well, for example, look at this new research, http://www.eurekalert.org/pub_releases/2007-05/foas-hca042007.php. They found an increased risk of brain lesions and high vitamin d intake. I'm not trying to scare people into not getting enough vitamin d to experience its benifits, but just because someone doesn't experince toxic effects of vitamin d at 10,000 IU doesn't mean its not damaging, so why advise people that its safe to have intake that high, its the benifits can be seen at dosages much lower. Again its about levels in the body not about how much you put in
You folks are so trying sometimes. Josh -- did you ever think that you might be seeing a skewed sample?
Use Medline people, it works. Here's the latest salvo in the IU Wars:
Council for Responsible Nutrition, Washington, DC 20036-5114, USA. email@example.com
The objective of this review was to apply the risk assessment methodology used by the Food and Nutrition Board (FNB) to derive a revised safe Tolerable Upper Intake Level (UL) for vitamin D. New data continue to emerge regarding the health benefits of vitamin D beyond its role in bone. The intakes associated with those benefits suggest a need for levels of supplementation, food fortification, or both that are higher than current levels. A prevailing concern exists, however, regarding the potential for toxicity related to excessive vitamin D intakes. The UL established by the FNB for vitamin D (50 microg, or 2000 IU) is not based on current evidence and is viewed by many as being too restrictive, thus curtailing research, commercial development, and optimization of nutritional policy. Human clinical trial data published subsequent to the establishment of the FNB vitamin D UL published in 1997 support a significantly higher UL. We present a risk assessment based on relevant, well-designed human clinical trials of vitamin D. Collectively, the absence of toxicity in trials conducted in healthy adults that used vitamin D dose > or = 250 microg/d (10,000 IU vitamin D3) supports the confident selection of this value as the UL.
OK? Repeat after me... there isn't an issue with 10,000 IU.
Oh, and yes Josh, I was referring to the lesion/vit D data, which at this point is NOT consistent with the corpus of knowledge. Withhold judgement on that.
I wonder if there is any work underway to study the possibility of Vitamin-D fortification of common foods beyond what is currently done in Milk in the US. This was recently done for folic acid with spectacular results in both neural tube defects and unexpectedly, apparently stroke prevention as well. This probably should be done for B12 as well as most cases of deficiency go undetected until the elderly victim starts have permanent brain damage and fortification with B12 could push this off by perhaps a year or two (although ultimately the loss of intrinsic factor will make problems inevitable).
I have heard reports on the radio where pediatricians in often-overcast Oakland were encountering a dramatic resurgence in pediatric osteomalacia in dark skinned children who were breast fed. This occurred despite the mothers often being on WIC, which encourages consumption of Milk. This seems to imply that there is insufficient transmission of Vitamin D from the mother to the child during breast feeding to prevent severe visible bone deformities, much less a reduction in latent disease risk that adequate Vitamin D intake seems to dramatically reduce.
Should at-risk children be monitored for vitamin D levels? This sounds like it might be expensive and applied in a inconsistent manner. Should we just give the mothers very large (i.e. 1000IU daily) doses of Vitamin-D to substantially boost their serum levels with the hope that this improves transmission during breast feeding? It sounds like there's risk of non-compliance and overdose.
I've often thought that WIC programs should encourage pre-natal vitamins and Omega 3 fatty acids. It seems that there is sufficient evidence that this is likely to produce a very cost effective gain in the health and intelligence of the children who need all the help they can get. Ultimately we all will pay in one way or another for the health problems of the disadvantaged as they grow up.
rsilvetz, I am curious about your background in regards to nutrition, you said that you have worked with nutritionists before? I understand what you are saying, what you have yet to address is the need for more standard testing of Vitamin D status. I cautious because I have just seen to many people take a headline, that this or that vitamin is good for health, then people go out and start megadosing vitamins thinking they are doing something to improve their health and it turns out they are causing more harm then good. Your thought?
A long time ago in a galaxy far far away I was both an M.D. and a scientist. I was happy doing some extreme computer science before a drastic return to cancer research on looking into the systemic failure mechanisms of the immmune system that allow cancer to take hold. Through this there was a major analysis of inputs into the immune system at the nutritional level to cause changes in receptor levels, survival times and activity against cancer.
I tend to follow my own path, but in answer to your question, my own interest in nutritional therapy began in 1984 with my entry into med school.
As to standardized testing, it wasn't particularly relevant to this conversation, also since most humans are not likely to get tested. It's the human factors reality. Nor should they, from a public health perspective, as it would be way too expensive. Cost-benefit plays here big time. If toxicity is reasonably nil at 10,000 IU, you simply put everyone on it and test by exception. If the cancer rate drops like a free-fall stone, it then pays to look at the outliers and find out who we are missing. But you certainly don't do it as a first pass.
Of course, knowing numbers via good surrogates, like a circulating free,unbound D3 level, would certainly be optimal. I'm not sure it's necessary unless there is some aspect of the vit D metabolism biodiversity that impacts that judgement.
As to the morons who megadose, well, in any gaussian distribution of people, you expect silly behaviors out at the tails...
From a public health perspective the cost of blood testing would out weigh the costs of treating the associated cancers? I do not follow, I am also concerned about the genetic factors. There are several VDR genotypes. The most important of these regarding cancer is Bsm I which has 3 variants: BB,Bb, and bb. The bb genotype occurs in 35% of the US population and is associated with lower circulating concentrations of 1,25(OH)2D. Men with the bb genotype were found to have twice the incidence of colon cancer as those with the BB genotype. Risk of breast cancer in women with the bb genotype was twice that of women with the BB genotype. Women with the bb genotype were 4 times more likely to develop metastases than those with the BB genotype. Approximately 40% of colon and prostate cancer may be related to the bb genotype. Educate me, does this 35% of the population need more vitamin D then others? How about people that don't have the bb genotype, do they not need to have nearly as high of intake of Vitamin D, and still not have issues with cancer. Again, if we are looking for optimal intakes, we need to move away from this one size fits all mind set, and look to use better and better biomarkers that indicate our individual needs.
I'll be astonished if this "60%" number is borne out. Really astonished. I'll bet a $40 donation to care.org that a year from now this is not accepted.
Hell, We're not even screening the population for your gene variants of Bsm and you want to screen everyone's vit D status... when logic alone tells you it's unnecessary.
The alternative to cost against is NOT "cost of treating all the cancers". You made that judgement -- that's why you are putting them on 10,OOO IU. Putting them on vitamin D outweighs the "treating cancers" alternative by orders of magnitude.
The cost alternative you have to worry about is putting everyone on 10,000 IU AND testing them for status, all 300 million in the US. Especially because it is unlikely, at this point, that the D3 supplement level that is free of complications will be much higher than 10,000IU. At most it can be 1-3x right? Can we agree that 1mg of D3 a day will do almost anyone in? I would be a nervous wreck at giving 750mcg even in a poor Vit D metabolizer. So if you drew the graph of people with satisfactory blood levels, would 10,000IU cover 90%? 95%? I bet it's north of 90%. And for the remainder what is the so-called partial benefit? In other words, does the reduction in RR for the outlier go up/down significantly if they are on 10K IU vs 15K IU? We need a study to answer that question, but historically, homocysteine is the only nutrient where we found this to be the case, with TMG supplementation.
There is a big difference between what you do as nutritionist and what you do to manage a population. As a nutritionist you want to individualize against biodiversity. As a population manager, the greatest benefit at the least cost. In this case, throw everyone on 10,000 IU and track longitudinally. In a couple years you know who to look for as outliers and you can do efficient screening.
Also there is a big difference between supplementing with a substance for prevention and testing status vs supplementing with substance that can induce cancer (e.g. hormone replacement) and testing. The forward looking odds are reversed between the two. In one case I'm trying to find outliers while reducing risk, in the other case I'm driving up their risk in a known way and it pays to look at status directly.
All my best.
It goes without saying, (at least no-one has said it) that the RDA is set for a worst case adult. A 45kg woman who is most sensitive to vitamin toxicity. If you weigh twice that for example (hardly an extreme case) then you can consume twice the RDA to get the same dose per bodyweight.
Likewise, stressors such as excercise will also increase the body's requirements for vitamins. And if you aren't one of these most sensitive people, you can up the dose again.
The nutritionists, especially government guidelines, only want to give one number, so they give the one that's safe for everyone.
Vee, I have already noted this study numerous times on here, if you had taken to time to read you would have seen that I made this contention in terms of safety and rsilvetz commented that the majority of evidence does not support this notion
I'm just not sure that testing Vitamin-D levels and treating accordingly is really practical for most people. Consider that about 40% of people in the US don't have their high-blood pressure treated correctly in the 21st century and this is a test using technology of the 19th century. It astonishes me every time I hear about people with full health insurance coverage spending 3 or 4 years with 150/100 blood pressure without treatment yet it seems almost as common as it getting treated appropriately with well-tolerated medicine.
Couldn't fortifying something like carbonated beverages produce an cost-effective increase? Maybe a lot more thought would have to be put into the appropriate fortification target due to the narrow population-wide therapeutic range of Vitamin-D to figure out what food nearly everyone consumes but not to excess.
"Elderly men and women who consumed higher levels of calcium and vitamin D are significantly more likely to have greater volumes of brain lesions, regions of damage that can increase risk of cognitive impairment, dementia, depression and stroke."
Do you know if the elderly people with increased brain lesions took calcium supplements, dairy foods, or vegetable sources of calcium? Or, would it not make a difference?
Thanks Josh (or whoever else answers too)
vitamin D deficiency should be eradicated totally...
vitamin D is very important to our health.. all should take its dose and should take care of their health as a precautionary measure..
"Elderly men and women who consumed higher levels of calcium and vitamin D are significantly more likely to have greater volumes of brain lesions, regions of damage that can increase risk of cognitive impairment, dementia, depression and stroke."
This research did not identify where the Vitamin D came from or what type it was. Those who know anything about Vitamin D intake are aware of the difference between natural and synthetic, D3 Cholecalciferol and D2 Ergocalciferol. The Case Against Ergocalciferol D2 is set out http://www.ajcn.org/cgi/content/abstract/84/4/694 here.
D2 is often used in fortified foods and has a track record of being the most likely to be involved in toxicity issues and is the version must often prescribed or used to fortify foods or provided in calcium/vitd --- multivitamin mixes.
While I would caution people against using the least effective, most expensive, most short lived and potentially more toxic form Vitamin D2, I'm sure most people would have healthier lives with optimal vitamin D3 status, which means raising levels to over 100nmol/L.
Circulating Vitamin D3 and 25-hydroxyvitamin D in Humans:
The research Josh referred to did not measure Vitamin D status, it simply looked at dietary intake of calcium/vit d. It could as easily be excess calcium in vitamin D deplete bodies that is the root cause of the brain lesion problem.
My husband was diagnosed with aggressive prostate cancer. He was taking 1100 IU of Vitamin D every day. I found the following article online stating that too much Vitamin D ups prostate cancer risk. http://www.cancerpage.com/news/article.asp?id=6665 After reading this article I threw all the Vitamin D supplements away. Now I don't know what to believe.
how intake of vitD and calcium help in a patient with nephrocalcinosis whose s.calcium,PTH,renal parameters are normal and vitD is normal at lower side.
The sunscreen manufactures our being taking to court y 'Massive class action lawsuits our going trough the courts Im schure the sunscreen manufacture will spend any amount to prevent any information from getting out.
Banana Boat and Copertone our 2 of the named listed in the lawsuits.
False advertising and missleading adds our the 2 points being mentioned in the suits as spf 30 is 97 % effective against only 1 type of uv rayz and spf 60 is 98% yet they keep making higher spf levels. In which they they sell for premium prices there defense is people wanted higher spf level we now there is no differance our they kidding.
The goverment is looking at imposing laws capping any sunscreen sold to a max of spf50
In australia spf30 is the maximum any sunscreen can be listed at i guess the us manufactures decided 50 is a good number to settle at.
As a parent with 2 children with OI
Osteogenesis imperfecta (OI) is a genetic disorder characterized by bones that break easily, often from little or no apparent cause.
OI is caused by genetic defects that affect the body’s ability to make strong bones. In dominant (classical) OI, a person has too little type I collagen or a poor quality of type I collagen due to a mutation in one of the type I collagen genes. Collagen is the major protein of the body’s connective tissue. It is part of the framework that bones are formed around. In recessive OI, mutations in other genes interfere with collagen production. The result in all cases is fragile bones that break easily.
After spending time in sick kids children hospital in toronto Canada
The specialist stated that my children need the sun as well as a healthy diet and activity
I also own a tanning salon were many health profressionals tan IE doctors and nurses
The only group refusing to accept that we need sun is the cosmetic industrie strange
IM waiting to here from the groups atacking the sun tanning industry were everyone is happy (that must be bad for there heath we would not want people feeling good lets put them on drugs)
How many anti depresents have been pulled from the market for adverse side effects .
Also the birth control pill has been listed in the same study they our quoting that tanning is bad
The birth control pill has been listed as a nown carsinagen yet strangely this litle fact has been omited in there press realeases.
Y do women suffer in much greater proportion with soft bone issues then men strangely since the cosmetic industry targets women with sun bloking products to be used 24Hrs a day this may have something to do with it i suggest researching this area.
How many studies have the cosmectics companies dunn im prety schure they have many. They should be forced by the goverment to present these same as the ciagarette companies have been forced to y would a company hide the info if it shows no health affects
The sun tanning industry will present and has presented every study it has dunn in full
Any time a study is quoted ask to see the full study so u can get all the facts and make a informed decision