Tag Archive for: vitamin D

Reality Check: Vitamin D

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Let me be clear. You should know how much of every dietary supplement you take and why you take it. If you exceed the amounts recommended on the label, you should also know why. But the case of the 89-year-old man who died because of an assumed excess vitamin D intake shouldn’t change a reasonable intake of vitamin D for anybody. Let’s take a look at what we don’t know.

Unanswered Questions

How much vitamin D was he taking? There is no indication that he took more than the upper limit. The assumption was that he was taking a very high amount, but wouldn’t there be receipts from pharmacies or groceries where he bought the supplements to deduce an estimate of how much he took?

Why did he decide to take more? Was he not feeling well? Someone with chronic heart disease and kidney disease might not feel all that great.

What medications was he taking? Was he taking those at the right time in the proper quantities?

One more: How do we know how he processed vitamin D? The assumption was that he mega-dosed on vitamin D, but what if he simply couldn’t process it well at 89?

About Exceeding That Upper Limit

For adults, the Tolerable Upper Limit (TUL) is listed at 4,000 IU (100 mcg), but that includes a safety factor of 6,000 IU per day. There were no observable events in the literature even at 10,000 IU per day, but to be safe, it was set at 4,000 IU.

Also, I’ve never seen a vitamin D supplement without a recommended amount to take. On the other hand, I’ve never seen a warning about consuming excess pharmaceuticals on the prescription bottles either. Buried in the flyer that comes with the prescription, yes, but not on the label.

The Bottom Line

Whether you’re 19 or 89, you should base your vitamin D intake on a vitamin D blood test. Vitamin D is not innocuous; take too much and it can be harmful. But there is nothing to fear in taking it in reasonable amounts to benefit your bones and your immune system. Physicians have prescribed 50,000 IU once a week for months to help people who need to raise their serum 25-hydroxyvitamin D (25OHD) levels. If it were not safe, it wouldn’t be used in that fashion. It also means you shouldn’t take it at a high level without guidance.

Again, base your vitamin D intake on the blood test and know why you take the amount of vitamin D you take. No reason to get extreme; just be reasonable.

The special pricing on the Real-Life Detox ebook ends tomorrow. The clocks change tonight, so it’s a good time to change your body with some spring cleaning.

What are you prepared to do today?

        Dr. Chet

Reference: Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Washington (DC): National Academies Press (US); 2011.

Vitamin D: Cautionary News

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Every once in a while, news on the suspected abuse of a dietary supplement makes headlines; such was the case when I read my news feed this past weekend. An assistant coroner in Surrey, U.K., declared the cause of death for an 89-year-old man was excessive calcium build-up due to high levels of vitamin D supplements. He was hospitalized in May 2023 and died 10 days later. The coroner’s report just released cited his vitamin D intake as a contributor to his death.

When more vitamin D is taken in than the body can process, the possibility exists that it can release calcium from the bones, which can then settle in the coronary arteries and kidneys. Heart and kidney failure were the actual causes of death. The coroner criticized the labeling on the supplement bottles because it contained no warnings. When queried, representatives of several U.S. medical schools talked about the “dangers” of exceeding the 4,000 IU (100 mcg) upper limit for vitamin D.

I think the man’s death was tragic, but I think everyone needs to take a deep breath. There are several issues related to this situation that weren’t talked about, and I’ll cover those in the Saturday Memo.

Remember, the Real-Life Detox ebook is on sale through Sunday evening. Laptop, tablet, or smart phone, you can spring clean your liver to get ready for the summer.

What are you prepared to do today?

        Dr. Chet

References:
1. https://www.express.co.uk/life-style/health/1872500/supplements-vitamin-d-warning-man-dies-overdose
2. https://www.ncbi.nlm.nih.gov/books/NBK56058/

The Supplementation Sweet Spot, Part Two

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We’ve got the beginning of our sweet spot for supplementation started with a multivitamin-multimineral and probiotics; today I’ll finish it up with two more—depending.

Omega-3 Fatty Acids

Recommendations on the type of omega-3s seem to be in flux with disagreements over docosahexaenoic acid (DHA). The cause for concern seems to be the potential relationship between DHA and atrial fibrillation. I’m still not satisfied as to the relevancy of the risk in the general population with one exception: those people who’ve had myocardial infarctions (heart attacks) that resulted in the loss of heart muscle. For now, those people may want to be cautious. My research continues and when I have an answer, so will you.

Unless you regularly eat servings of cold-water fish two or three times a week, part of your foundation supplementation should be 1–3 grams of EPA, DHA, or the plant-sourced alpha linoleic acid (ALA), or a combination of all three. You can pick any body system, and omega-3s are most likely beneficial. This is especially true of the cardiovascular and nervous systems.

Vitamin D

The final foundation supplement that makes up our sweet spot is vitamin D but with a catch. Instead of taking massive amounts of vitamin D, the best way to determine whether you need to supplement with vitamin D is to get your blood levels checked via a 25 hydroxyvitamin D (25(OH)D) blood test. If you’re low in vitamin D, below 30 ng/mL, add more vitamin D to your supplements in 50 mcg (2,000 IU) increments until your blood level reaches 40–60 ng/mL. Obviously, you need to see your doctor for the test, but you should be seeing your doctor regularly anyway.

Depending on where you live, sunlight will help you maintain healthy vitamin D levels with about 15 minutes exposure per day. However, in Northern areas such as here in Grand Rapids, that only happens about half the year, so we make sure to take our vitamin D supplement and bump it up a little in winter.

More

Vitamin D has become controversial with the current COVID-19 outbreak. Vitamin D will not prevent you from catching COVID-19; it will help reduce the severity of symptoms. But megadosing on vitamin D can have consequences that can result in bone loss. That’s why basing your intake on a blood test is the right way to go.

The Bottom Line

There you have the sweet spot for foundation supplements that all of us need, regardless of the quality of our diet. What about all those other supplements out there? Fine tuning supplementation to meet your personal needs is where supplements get complicated and need to be personalized. With the billions of dollars spent on supplements every year, if everyone began with the sweet spot of foundation nutrients, everyone would be better off, just like the sweet spots for diet and exercise.

If you want to know more about the science behind these supplements as well as how to assess a quality manufacturer, get a digital copy of Supplementing Your Diet; if you want to pass along the information to others, get a 5-pack of CDs at reduced prices. They’re all on sale at 25% off, and that’s in addition to Member and Insider discounts. You can also find info on supplementation for other conditions such as high blood pressure, pregnancy, migraines, weight loss, and more at the Store at drchet.com.

What are you prepared to do today?

        Dr. Chet

New Research on Vitamin D and COVID-19

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The research confirming the benefit of adequate levels of higher vitamin D (25-hydroxyvitamin D) blood levels keeps growing. In this Memo, I’m going to cover two of the most recent studies, both observational studies; the researchers were able to obtain vitamin D levels from medical records after subjects were admitted with COVID-19 infections.

Study One: Vitamin D and COVID-19

The first study was conducted at two medical centers in the Boston and New York City areas. Participants were hospitalized adults with confirmed cases of COVID-19 between February 1 and May 15, 2020; 144 patients, median age of 66, were included in the final analysis. Overall mortality for all subjects was 18%. However, in subjects with vitamin D levels greater than 30 ng/ML, the mortality rate was 9.2% versus 25.3% in those with vitamin D levels below 30 ng/ ML. The researchers concluded that patients with COVID-19 who had levels greater than 30 ng/ML had lower mortality rates and did not require mechanical ventilation to the same degree as those who did not have adequate vitamin D levels.

Study Two: Vitamin D and COVID-19

In the second study, researchers did a chart review of all COVID-19 patients over 18 who were hospitalized in a Boston Medical Center. All patients were positive for COVID-19 and had a vitamin D test in the prior year; 287 patients were included in the analysis. Of those, 14% of all patients died during the hospitalization; 100 out of the 287 had vitamin D levels greater than 30 ng/ML.

Focusing on those patients over 65, they found that patients with normal levels of vitamin D had a 67% decreased odds of dying, 78% decrease risk of acute respiratory distress, and 74% decrease in severe sepsis or septic shock. There was a similar relationship, even if subjects were obese as assessed by BMI greater than 30.0 kg/m2.

The Bottom Line

These two studies add to the body of work that suggest that adequate levels of serum vitamin D are essential for reducing symptoms and mortality for COVID-19, especially in those greater than 65 years of age. It does not mean that it’s time to start mega-dosing on even more vitamin D than you may be taking.

What it means is that you should get a vitamin D test to find out where you stand. We have no idea whether any of these people took vitamin D, and if they did, we don’t know how much they took. If you really want to age with a vengeance, then approach things in a stepwise manner. You don’t start on a solution before you know if you have a problem. So get a vitamin D test scheduled and then you can make an informed decision about whether you’re taking an adequate amount of vitamin D or you may need to up it a bit.

If you’re thinking, “Nah, COVID is almost gone,” think again. Yes, many of us are now fully vaccinated, but the new variants are so lethal that we can’t ignore them, and too many people seem to have “Superspreader” as their goal. Keep your defenses up, because you don’t want to be one of the very last people to die of COVID-19. Let’s finish this race strong—and then have a cook-out.

It’s time for spring break so Paula and I will be taking some time off. We’ll be back with the next Memo on April 13. Have a safe and healthy spring break and any holiday you may celebrate. What are you prepared to do today?

        Dr. Chet

References:
1. Mayo Clin Proc. 2021. doi: 10.1016/j.mayocp.2021.01.001.
2. Endocr Pract. 2021. doi: 10.1016/j.eprac.2021.02.013.

Vitamin C, Zinc, and COVID-19: Ask the Right Questions

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As we left off Tuesday’s memo, I suggested that both the researchers in the study that was halted as well as the physicians who used dietary supplements as part of their treatment were wrong in their conclusions. At this point we don’t know for certain whether vitamin C and/or zinc can help with COVID-19.

Let’s define which questions we’re asking. Are we trying to prevent people from catching COVID-19? Are we trying to help them recover from a COVID-19 infection? Are we trying to prevent hospitalization? Are we trying to prevent death? Those are all different questions.

The Videos

Let’s stick with helping people recover once they’ve been infected with COVID-19. At this point, we don’t have solid data as to how long the patients were infected before they sought treatment, how many days it took them to fully recover, or if they recovered without any further treatment of any type. We also get no data on the people who needed further treatment in the hospital.

It’s not reasonable to suggest that every patient seen in these physicians’ videos all recover and no one ever gets worse, but that’s never discussed.

The Research

As for the researchers, they didn’t ask two very valuable questions: what were the subjects’ vitamin C and zinc levels before the treatment began? Without that measure, they couldn’t know whether they needed supplements; maybe their levels were as high as needed, and they didn’t need any more.

Second, how did they administer the vitamin C? If they were familiar with the research, they’d know vitamin C is more effective when given intravenously. The subjects could have been given vitamin C on an outpatient basis to begin, and then used supplements for the rest.

The Bottom Line

Neither group really provides us with much information about vitamin C and zinc to help people recover from COVID-19. When it comes to the use of dietary supplements and COVID-19, there’s a difference between preventing a person from catching the infection at all, reducing the number of days that they’re infected with the virus, and reducing the risk of having the infection progressing to hospitalization and potentially death.

Where does that leave us? Now more than ever, we should support our immune system. Vitamins D, C, and the mineral zinc can help us do that, and at the first hint of illness I’d recommend the Immune Boost supplements. I’d also like to recommend getting tested for C and zinc as we do for D, but it’s not practical at present.

Most multivitamin-multiminerals can provide a baseline to get you started. Don’t forget food has nutrients as well, so a healthy diet may help you stay COVID free.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Network Open. 2021; doi:10.1001/jamanetworkopen.2021.0369

Vitamin D and COVID-19: What Would a Reasonable Person Do?

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The Medscape article did not call for any conclusions or recommendations nor should it have. That’s not the purpose of that type of article. However, that didn’t stop healthcare professionals from voicing their opinions in the comments section of that article. We’ll take a look at what they said, discuss the potential benefit of vitamin D testing and supplementation for COVID-19, and determine what a reasonable person should do.

Comments Abound

I rarely read the Comments section on any posting. There’s no point, because people will disagree about almost everything, especially when interpreting scientific information. If you think people attack people only on social media, not true; academic arguments can get really vicious.

There were not just comments about the Medscape article, but about what people posted in response to the article: accusations of “junk science,” “pseudoscience,” or “snake oil salesman.” These are healthcare professionals at all levels going after one another. They may not use the same language, but the insults and accusations about being shills for pharmaceutical companies are still there. You see the condescending attitude of some physicians about research and the opinions of people who treat patients with supplements. The end result is the same as a Twitter fight; it accomplishes nothing beneficial.

Potential Benefit of Vitamin D

Within the Medscape article was a reference to an article that hasn’t been peer-reviewed yet. That paper attempts to quantify the relationship between vitamin D deficiency and extreme responses to COVID-19 infections. They looked at vitamin D and C-reactive protein (CRP), a marker that indicates inflammation. CRP is depressed in severe cases of COVID-19 infection but not as depressed in milder cases of infection.

They found that “the risk of severe COVID-19 cases among patients with severe vitamin D deficiency is 17.3% while the equivalent figure for patients with normal vitamin D levels is 14.6%; that’s a reduction of 15.6%.” Understand that this paper makes many assumptions about the relationship between vitamin D status and CRP that may or may not be correct. However, if the number of severe COVID-19 cases resulting in deaths in the U.S. were reduced by half that amount, that would mean thousands fewer deaths.

The Bottom Line

I began this by asking the question “What would a reasonable person do?” That’s a term often used in legal matters, but I think it applies here as well. Based on the Irish study, optimal vitamin D levels should be maintained between 50 to 60 nmol/L. You would need a blood test to find out if you’re there. If your physician is not amenable right now, use the last vitamin D test you had as the base level. I just had my blood work done in the past couple of months, and it was 30 nmol/L. If you’re in the optimal range, keep doing what you’re doing.

If you’re low, as I was, it’s time to increase your vitamin D intake. This is especially true if you have a comorbidity such as being obese, having type 2 diabetes, an autoimmune disease, asthma or another lung disease, or are over 60. Talk with your physician about increasing your vitamin D intake. By how much? You could safely increase your intake by 1,000 to 2,000 IU or 25 to 50 mcg, but get your doctor’s input on whether you should take a higher amount for a while to increase your vitamin D levels faster.

As I said a week ago, respect this virus. One of the ways you can do that is by treating your body as any reasonable person would, including getting your vitamin D to optimal levels.

What are you prepared to do today?

        Dr. Chet

References:
1. Irish Med J. 2020; 113 (5):81-88.
2. Vitamin D: A Low-Hanging Fruit in COVID-19? – Medscape – May 17, 2020.
3. doi: https://doi.org/10.1101/2020.04.08.20058578

Vitamin D and COVID-19: Debating the Research

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The paper published in the Irish Medical Journal inspired a lot of commentary by healthcare professionals in all forums. I selected one report from Medscape, an online journal I subscribe to, that summarized all sides of the issue. The writer interviewed a variety of vitamin D experts including the authors of the study in the Irish journal.

The predicted response came from a researcher in Maine: there are no randomized controlled trials, scientific research’s gold standard, that prove that raising vitamin D levels will protect against serious COVID-19 infections. That’s not quite as harsh as it sounds. He recognizes the importance of vitamin D—he’s studied it for 25 years. He’s just stating the facts as he sees them.

The author of the original paper acknowledges that but suggests that because a deficiency in vitamin D can be remedied quickly with vitamin D supplementation, let’s grab the low-hanging fruit and act now with minimal potential for side-effects or negative outcomes. A leading epidemiologist suggests that for some people, vitamin D may reduce the risk of the “cytokine storm” that happens to some people that leads to death from the virus.

What are we supposed to do with such disparity between experts? You haven’t seen anything yet, but we’ll come up with some recommendations on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. Irish Med J. 2020; 113 (5):81-88.
2. Vitamin D: A Low-Hanging Fruit in COVID-19? – Medscape – May 17, 2020.

Vitamin D and COVID-19: Upside-Down World

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Vitamin D has been in the health news as it relates to the COVID-19 virus. Are vitamin D levels related to the severity of symptoms if you’re exposed to the virus? We’ll take a look at a recent observational study and the medical responses to it this week.

There have been reports that people with higher vitamin D levels in their blood were doing better in response to the COVID-19 infection than those with lower levels. Researchers in Ireland decided to check that out in a unique way. Using epidemiological data from European countries that were hit with the COVID-19 virus, they found something interesting. Countries such as Spain and Italy that had more sunshine had lower vitamin D levels and did poorly in response to the virus. Countries in northern Europe such as Norway and Finland with their short winter days had higher levels of vitamin D and did better in response to the virus.

This is counter to what we would expect. The higher the sun, the higher the vitamin D, right? Evidently not. What was the difference? Due to the lack of sunshine in the north, supplementation with vitamin D was recommended by government health agencies, but there were no vitamin D recommendations in the southern countries. Is vitamin D the solution to this COVID-19 virus? Nothing is ever quite that simple, as we’ll find out on Thursday.

What are you prepared to do today?

        Dr. Chet

Reference: Irish Med J. 2020; 113 (5):81-88.

Research Update on Vitamin D

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Vitamin D supplementation always seems to be in the health news; one day it’s beneficial, the next not so much. One of the problems is that many studies are observational studies. They take a large group of subjects, such as the Nurses Health Study, use food frequency questionnaires to assess vitamin D intake, and report on bone health and other outcomes over time. That has serious limitations in my opinion, not least among them the reliance on food frequency questionnaires, which have been proven inaccurate. Do you remember what you had for dinner last week or the week before? Neither do I.

In a recently published study, researchers did a meta-analysis on vitamin D in observational studies, randomized controlled trials (RCT) on vitamin D supplementation alone, and RCT on vitamin D plus calcium supplementation. The outcomes were all fractures and hip fractures, and the subjects were mostly older than 65.

While there were issues in just about every observational and RCT of some sort, the analysis of each type of trial combined was that vitamin D supplementation did not have a significant effect on the rate of fractures. However, when vitamin D supplementation was combined with vitamin D and calcium supplementation, there was a 6% decrease in all fractures and a 16% decrease in hip fractures over an average of six years. The amounts of vitamin D used were 400 to 800 IU and 1000 to 1200 mg of calcium per day.

While there’s more research to go including the completion of some of randomized controlled trials used in the analysis, take vitamin D and calcium together to reduce the risk of hip fractures and other broken bones. Better together seems to be more effective than overdoing it on a single nutrient.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Network Open. 2019;2(12):e1917789.

New Research Yields One More Factor

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The last recommendation for you in living every day you’re alive involves keeping the body working its best through regular maintenance. That means seeing your healthcare professionals on schedule. Here are some examples of what that can mean.

Researchers recently published a paper on the impact of a narrow band of ultraviolet light on the microbiome. If people were deficient in vitamin D, their microbiome was not as healthy as those who had normal vitamin D levels. The UV light did not improve the microbiome of those who had normal vitamin D levels, only those who did not. That’s why you need to get your bloodwork done regularly, including getting your vitamin D levels checked. Whether by sun or supplement, vitamin D is critical to your microbiome and many other aspects of your health.

A couple of years ago my glasses were broken and I needed a new prescription, so I finally had my eyes examined. It had been at least five years since my last exam. Turns out I have glaucoma; by using a couple of drops a day, I haven’t lost any vision. But if I hadn’t had my eyes checked, who knows what could have happened?

One more. It seemed like I kept getting shorter and shorter every time I had a checkup, so I had a bone density test done. Turns out I have osteopenia. Long-time runners like me aren’t supposed to get that, but there it is. I changed my supplements and I’ll get checked again this year.

I’ve often talked about the importance of protecting your dental health. Yes, teeth can be replaced, but it’s really expensive as Paula and I know from experience. While a dental checkup may seem like lot of money, it’s worth it to protect not only your teeth, but many other aspects of your health such as heart and digestive health.

Today’s lesson is get your body checked on a regular basis. We don’t ignore our hearts (for the most part) but the ability to see, to hear, to have strong bones, even to chew food is dependent on taking care of those specialty organs on a regular basis.

What are you prepared to do today?

        Dr. Chet

Reference: Front. Microbiol., 24 October 2019 | https://doi.org/10.3389/fmicb.2019.02410.