Vitamin D: Now I'm a believer
One of the most electrifying sessions I attended at Andrew Weil's Nutrition and Health Conference in April was one given by Dr. Michael Holick on Vitamin D. Dr Holick is a well-known, even notorious, name in nutrition research circles. He's been insisting for years that vitamin D deficiency is far more wide-spread and dangerous than anyone realizes and he has a reputation (which he himself promotes!) of being a bit of a kook.
A few years ago, he was famously booted from the Boston University dermatology faculty for making heretical statements about the benefits of moderate UV exposure (which stimulates the production of vitamin D in the skin) and has been chided and derided by the dermatology establishment ever since.
I thought I had a pretty good idea of what to expect from Holick's presentation; it would be all about the miraculous powers of vitamin D and the dire consequences of deficiency. I tend to take these sort of Wonder Nutrient presentations with a grain of salt. When you spend your whole life researching a single compound--like many of these researchers do, I think you can start to lose your sense of perspective. As the old saying goes: When you're holding a hammer, everything starts to look like a nail.
The evidence is always reasonably compelling. And by the end of every Wonder Nutrient presentation, you find yourself thinking, I really should start taking that, and I should probably start recommending it to my patients, too. The problem is that after a few dozen of these presentations, you (and your patients) have a list of 40 nutrients that you "need" to be taking.
It's probably a backlash against too many Wonder Nutrients but, as many of you know, I'm not all that big on dietary supplements. Whenever possible, I think it's better to meet your nutritional needs with actual foods. I myself take very few supplements. And I have become immune to the persuasive power of Wonder Nutrient lectures.
And yet, after hearing Dr. Holick's presentation, I literally stopped on my way back to the hotel to buy a bottle of vitamin D (1000IU).
First, I've gotta say, if you ever have a chance to see this guy speak, don't miss it. All 1,200 of us in the audience were blown away (300 slides in 50 minutes). But it wasn't just his over-the-top presentation that made me break my ban on Wonder Nutrients. It was the cumulative impact of the data.
To me, the most compelling reason why vitamin D is really in a category of its own, and why most people need far more vitamin D than they can ever get through their diet, is this: Our bodies were not designed to meet our vitamin D requirements through dietary sources--we evolved to produce vitamin D in our skin, when the sun hits it.
That's why people who originally lived further from the equator have lighter skin--it allows more UV rays to penetrate, which compensates for the weaker rays at those latitudes. The traditional diet of the northern and southern latitudes is also more likely to include oily fish, the richest dietary source of vitamin D.
But now, most of us spend most the daylight hours indoors. Any skin that is showing is slathered in sunscreen to prevent skin cancer and wrinkles. We don't eat much cod liver. We get most of our vitamin D from fortified dairy products and vitamin supplements, but it's not nearly enough to meet our requirements.
Holick claims that the majority of Americans are chronically and dramatically D-deficient. Among those at particular risk are those with dark-skin, the elderly, the obese (because vitamin D tends to become trapped in fat cells) and anyone living about the 35th parallel (which runs through Arizona and Georgia). That is the latitude above which it is impossible to manufacture vitamin D in the winter months, even (as Holick to colorfully pointed out) you were to stand on the roof stark naked from noon to 3pm every day.
So what?
Every cell in the body has a receptor for vitamin D. Low blood levels of vitamin D are strongly linked to increased rates of cancer, osteoporosis, chronic pain syndromes, multiple sclerosis, rheumatoid arthritis, Type I diabetes, and hypertension.
In fact, if you chart deaths from colon cancer, prostate cancer, or multiple sclerosis geographically, you can pick out the 35th parallel by eye because the difference in mortality rates is so much higher above that line. (Deaths from multiple sclerosis are 100% higher above 37 N. than below it! )
There's much more to Dr. Holick's argument (about 280 slides worth) but suffice it to say, I'm a believer. Vitamin D is now one of only three nutrients I take as supplements (along with fish oil and calcium).
Dr. Holick and others are compaigning to have the government recommendations for vitamin D increased from the current recommendation of 200 - 600IU (depending on your age) to 1,000IU of vitamin D3 (cholecalciferol) for everyone. Based on his data, I support that recommendation.
Note: Vitamin supplements containing vitamin D2 (calciferol) are only about half as potent as D3 (cholecalciferol). Also, be cautious with sources that contain both vitamin D and vitamin A (such as supplements or cod liver oil) and be sure that the amount of vitamin A (retinol) that you're getting from all sources does not exceed 10,000IU.
For more information on vitamin D and health, visit Dr. Holick's site at http://vitamindhealth.org/
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Posted by: Michael West | Aug 24, 2009 2:22:13 PM
New research demonstrates that ingested vitamin D is immunosuppressive and that low blood levels of vitamin D may be actually a result of the disease process. Supplementation may make the disease worse.
Ref:http://www.sciencedaily.com/releases/2008/01/080125223302.htm and http://autoimmunityresearch.org/transcripts/AR-Albert-VitD.pdf
Monica's Response: A very interesting addition to the debate and one that deserves attention. I'll be interested to hear what Holick and other pro-supplementation experts have to say in response to Albert's paper. (I've got emails out to several). In the meantime, a good argument for sunshine as a better source of vitamin D.
Posted by: Funny Pictures | Jun 20, 2009 11:17:31 AM
Nice article on Nutrition, thanks for giving so much information like my funny pictures.
Posted by: Karen | Jan 16, 2009 7:42:29 AM
You should take a look at this report from WHO's working group, who have collected all research on vitamin D and cancer and made a thorough review.
http://www.iarc.fr/en/Media-Centre/IARC-News/Vitamin-D-and-Cancer
The "evidence" that vit D is such a great molecule and that you should take much higher doses than recommended should be read with care and precaution. Holick is a great speaker - I've heard him - and it's easy to be convinced by his data and personality. But he only shows one side of it.
Noone knows exactly what level of vit D that is the optimal. It's been shown that people who a vit D deficient have shorter life expectancies - but noone knows if this is because bad health gices vit D deficiency or if it's vit D that gives bad health.
The data Holick uses is not good enough to make conclusions, and more research is needed in order to understand how vit D functions in the body. It may well be that we should increase our levels, but it should be done in a controlled way, not as a religious belief which seems to be what's happening now.
Karen
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Posted by: Ryan W. | Jun 27, 2008 3:21:29 PM
I found a blog post that makes an interesting argument that some of the studies showing lower Vit. D linked to increased mortality in osteoporosis and autoimmune disease are showing an effect of infection and Vit. D receptor disregulation rather than simple deficiency.
You won't find any actual research that shows vitamin D + calcium increases bone density above calcium alone, though some people
still assert that conclusion. Vitamin D raises blood levels of calcium, yes. But not bone density.
Many people with low 25D have high 1,25D which is a product of 25D
That argues against deficiency in some cases. And in favor of infection + occasionally dysregulation of the Vitamin D Receptor resulting in overproduction of
1,25D from 25D (which leads to low levels of 25D, which appears like deficiency)
bacteriality.com/2007/09/15/vitamind/
They say high levels of 25D deactivates the Vitamin D receptor based on molecular modeling, though. That part I question. How much D3 supplementation does it take to maximize cathelidicin production?
I cannot find an answer to that question, and it should be simple.
Posted by: Theresa | Jun 14, 2008 12:49:44 AM
My comment should read:
...by saying babies cannot get a necessary nutrient "while breastfeeding" and then trying to prove...
Posted by: Theresa | Jun 14, 2008 12:47:04 AM
I just watched the speech given by Dr. Holick and am amazed that anyone would think they need to take vitamin D. I think anyone who begins by saying babies cannot get a necessary nutrient by taking vitamin D and then trying to prove that you can't take too much of a fat soluble vitamin is being paid by someone.
Posted by: Monica Reinagel | May 21, 2008 1:23:39 PM
Wally,
you can buy vitamin D3 as a dietary supplement, without a prescription.
Posted by: Wally | May 20, 2008 4:57:39 PM
I read in one of the articles on Dr Hlick's website that "...vitamin D3 is not available in the US as a pharmaceutical preparation..." yet this and other posts are full of remarks about using D3.
What am I missing ?
Posted by: Neal Gallagher | May 19, 2008 4:05:56 PM
Heres a link with a recent interview with Dr Holick and Dr Howd on Vitamin D: http://www.peoplespharmacy.org/podcast-show.xml
Posted by: Neal Gallagher | May 19, 2008 4:05:31 PM
Heres a link with a recent interview with Dr Holick and Dr Howd on Vitamin D: http://www.peoplespharmacy.org/podcast-show.xml
Posted by: Lynn Kevekordes | May 19, 2008 11:54:43 AM
what about getting UV exposure via tanning beds?
Posted by: Monica Reinagel | May 4, 2008 12:42:27 PM
Jim,
thanks as always for your thoughtful contributions. It's a good point about high altitudes and perhaps the statement should be modified to include "below XX feet above sea level."
Also, in fairness to Dr. Holick, he is not proposing that supplements replace moderate, responsible sun exposure, for many of the same reasons you suggest: vitamin D is not the only photoactive compound created in the skin when exposed to UV and these lesser known compounds may play a valuable role.
So, supplementation is, in my mind, a fall-back for those who--for whatever reason--cannot or will not get adequate daily sun exposure. This might include the elderly, those living at low altitude above the 35th parallel in winter, and dermatologists. ;-)
Although supplemental D3 may not be quite as effective as UV exposure, it's inexpensive, quite safe, and certainly better than the consequences of low serum D.
Posted by: Jim Kent | May 4, 2008 2:03:19 AM
I've read repeatedly claims that you simply can't synthesize vitamin D in the winter up north, no matter how much sun you get. I find this very difficult to believe. I haven't been able to find a proper scientific source for this. If someone knows one could they send it?
The reasons I find it hard to believe are
1) You certainly can get sunburnt in the winter at high latitude. Witness the red and peeling noses of many people who ski.
2) The light energy needed for the synthesis reaction is, like all light energy, carried in quanta. Though you will get fewer quanta if the light is less intense, the quanta themselves are of the same power. This means the synthesis will proceed, just more slowly.
3) People living in the north have been selected by evolution for white skin, unless, like eskimos, they eat lots of fish. If they couldn't synthesize vitamin D better in the winter this would not help them. Vitamin D stores, but not that well. Since there is 15-20 hours of sun in the summer up north as opposed to 12-14 at more moderate latitudes, if they could store the Vitamin D all year, they wouldn't need to get white either.
4) I feel personally a lot better when I do get skin exposure to sun in the winter, even though I am to the north of the 35th parallel.
I'll also note that Vitamin D is not by any means the only thing we need sun to synthesize. Supplements as ever should be a backup, not a substitute for what nature provides. Some of the other *known* effects of sunlight:
1) Helps break down bilirubin, a somewhat toxic breakdown product of hemoglobin.
2) Helps (not just through the eyes, but through the skin) keep your 24-hour rhythms in sync - so you're tired at night, not during the day.
3) Helps avoid seasonal depression.
There are I think most likely many other effects, many positive, which we don't know. Moderation is clearly necessary. You don't want to court sun burn or skin cancer. 15 minutes a day of sun is plenty for Vitamin D synthesis. Still, to slather yourself with sunscreen and rely just on supplements is to fall for the the same sort of naive reductionist scientific thought that brought us the use of trans-fat filled margarine instead of butter to avoid heart disease, and that brought us the use of infant formula instead of breast milk since you could make infant formula so much more sterile..... Science does self-correct, even when it's of the naive and reductionist sort. The problem is when applied to matters of human health it can take 100 years to correct, because the problems can take 50 years to manifest, and another 50 years for the causes to be nailed down. Well, that's what it took with trans-fat anyway.....
Sorry to go on about this for the third time. I'll give it a rest for another month or two now, I promise. ;-)
Posted by: Floyd H. | May 3, 2008 12:59:37 AM
Great reporting Doc!
I've been taking 4k IU /d for 6 months, and feel phenomenal - both physically and mentally. Having worked the night shift for years had really taken its toll. Now I feel much more like when I was 18 and would get 'high' spiritually after a day at the beach. I now think this is a basic reason why folks flock to my state of Florida each year on vacation.
Your observation about the cynicism among the general public toward 'wonder nutirents' is spot on. I often see peoples eyes 'gloss over', when I begin to rant about the miracle of D3. I've come to learn the aptness of the old maxim that 'you can lead a horse to water, but...' People have become numbed by the vast numbers of new drugs on the market lauded as panaceas.
This realisation the the human body may need as much as 10x the current RDA of 400 IU is has far reaching consequences. I am aware of both the placebo effect and the minds effect on the health of the body - yet this feels extraordinary. Something like a quarter of a million have cancer in America, and there is reason to belive that adequate serum D3 chlecalciferol levels could conceivable reduce that rate by half !
Your remark; '"Our bodies were not designed to meet our vitamin D requirements through dietary sources--we evolved to produce vitamin D in our skin, when the sun hits it." is what I think many overlook. When I read news reports I feel crestfallen because they rarely mention that it is the level of D3 that is critically important, and having failed that are always sure to mention the toxicity issue, which I understand to be that similar to water intoxication.
If evolution designed us to acquire 10 to 50k IU in as little as 20 mins, then how can anyone belive 400IU to be remotely sufficient?
There is also the mental health aspect, and because psychology is not a 'hard science' convincing people of the ameliorating effects of D3 on depression and other aspects of mental health - is in my opinion not getting any coverage.
As this is turning into a rant, let me close by congratulating you for being to my mind one of the few to bring up this important issue. You are in a postion by virtue of your professional credentials that others might listen to you. We're talking about billions of dollars in medical bills, and perhaps millions of people dying needless, horrid, early deaths - so you'll forgive my zealousness?
$8.00 for a 100 count bottle of 2k IU D3. + lack of patent = Big Pharma Conspiracy?
Posted by: Monica Reinagel | May 2, 2008 12:58:28 PM
Jan,
see today's post on vitamin A, in which I answer your question and a few others on vitamin A.
