Saturday, December 6, 2008

Physiologic Actions and Benefits of Vitamin D: CARDIOVASCULAR

Dr. Schwalfenberg MD has written a wonderful review about the wide range implications of vitamin D insufficiency and the potential adverse impact on Canadian citizens. The above figure delineates how vitamin D affects all organ systems in humans. He however failed to list (1) the benefits for vascular atherosclerotic plaque remodeling which Dr. Davis has deep experience with, (2) Thyroid (he does discuss Parathyroid -- which the 2 are intimately related), and (3) modulation of the cholesterol/steroid/testosterone/estrogen reserves. Otherwise, I believe this is one the best comprehensive reviews done on the studies so far generated regarding vitamin D. Dr. Schwalfenberg has even included a brief mention about how medical residents were deficient due to long hours working indoors (Haney EM, Stadler D, Bliziotes MM. Vitamin D insufficiency in internal medicine residents. Calcif Tissue Int 2005;76(1):11-6.20). I liked that one.

Who is Vitamin D deficient?

He implies that nearly EVERYONE (greater than 50%) in Canada is either insufficient or deficient in Vitamin D due to the northern location of Canada relative to the equator. In Table 1, he cites a succint list (2 pages long) of the clinical trials and epidemiological studies on various subpopulations (including the medical residents). Below is Table 5 which lists Risk Factors for Low Serum Vitamin D levels.

The definition of 'insufficient' however begs a little argument. Less than 25 nmol/L (U.S.: 10 ng/ml) is considered clinically deficient at this time and less than 80 nmol/L (32 ng/ml) is clinically insufficient. Fortunately, the tides are changing and the awareness of the populace is increasingly demanding for this sunlight hormone. Costco warehouse carries the 1000 IU tablets and Long's and CVS pharmacies carry it as well; Oprah recently discussed vitamin D in reference to her recent-onset Hypothyroidism -- Oprah, honey, are you still consuming W-H-E-A-T ?? Oprah's magazine has a piece HERE about how various Maternal/fetal Vitamin D Deficiencies may determine our astrological zodiac behavior, characteristics and traits. Interesting, huh?? Science meets popular wisdom *hee* and it lights up Oprah's community board HERE.

At Track Your Plaque (and other expert communities), the optimal target goal for Vitamin D blood levels is 25(OH)D = 70 ng/ml (translates to: 70 * 2.5 = 175 nmol/L).

Cardiovascular Actions and Benefits of Vitamin D

With the addition of Vitamin D to the arteriosclerosis reversal program, Dr. Davis witnessed countless cases of regression of CAC/plaque (coronary artery calcium score) and improved benefits of many organ systems. For the LEF mag, he wrote a fantastic, complete review about the basics of Vitamin D and its role in cardiovascular health. HERE is the PDF for September 2007 Vitamin D’s Crucial Role in Cardiovascular Protection.

He writes about Vitamin D so frequently on HEARTSCANBLOG, it's a topic that certainly becomes hard to ignore, right? Assessing serum Vitamin D was actually my first introduction to the TrackYourPlaque program and why it is so effective in initiating and maintaining longevity and optimal health. Is the medical science and the establishment still millenium behind us? Or...suddenly are they starting to play catch up with Dr. Davis -- our favorite interventionalist and humble icon? The latest title from JACC: Holick MF. STATE-OF-THE-ART PAPER: Vitamin D Deficiency -- An Important, Common, and Easily Treatable Cardiovascular Risk Factor? J Am Coll Cardiol, 2008; 52:1949-1956. Wow, he finally got into JACC.

Let's review what the medical science so far says:

My Personal Experience with the Physiologic Actions and Benefits of Vitamin D

I never would've suspected that I had Vitamin D Deficiency -- I'm a tan Asian female who spends significant time in the sun esp in the summer Cali season when my children swam nearly everyday. I'm into skin cancer prevention so naturally in the past I lathered our bodies up with sunscreen (though as a kid my parents NEVER did b/c sunscreen did not exist, but then again we didn't wear seatbelts either). I didn't have an autoimmune disease I thought (although later I found out my asthma has autoimmune components -- oops -- I didn't learn that in school during the Pathophysiology of Diseases classes). After diligently reading the blog, PubMed (which confirmed what Dr. Davis and other experts like Holick, Heaney, Vieth, Cannell and others try to publicize), and some internet sources (ie, WAPF) for several weeks, I decided to get my 25(OH)D vitamin D blood level evaluated. In October 2007 my 25(OH)D was only ~20 ng/ml. The TYP recommendation at the time was 50-60 ng/ml. The current target by Dr. Davis is now 60-70 ng/ml. I started on 2000 IU daily for 4 weeks however my level didn't reach 50 and I didn't notice any benefits. I finally upped the level to 4000 IU daily in the AM (outside of the recommendation of the Endocrinologist that I -- against better judgement -- consulted individually with) and achieved > 60 ng/ml by December 2007.

The benefits I noticed were myriad and echo the things Dr. Davis talks about on his blog and other writings:
--better energy, mood, endurance
--more muscle growth
--resistance to colds and infections
--MY ASTHMA COMPLETELY WENT AWAY and I stopped having bronchitis every year (coughing for 4-8 wks at a time where antiobiotics and inhalers were useless and futile)
--my children's asthma resolved (no more inhalers for us) with supplementation 1000 IU daily in the AM (in addition to cod liver oil (CLO) + fish oil)
--20% increase in HDL (from 70 to 84 mg/dl)
--40% drop in TGs (from 50s to 30s)
--improvement in mild insulin resistance
--calmer and more regular heart rhythms
--improvement in my estrogen (despite the contraceptive suppressing most of it)
--resolution of SAD (seasonal affective disorder, 'winter blues')
--resolution of Reynaudy-type symptoms (cold extremities, poor circulation)
--reversal of periodontal gum disease
--reversal of the other plaque hopefully *fingers crossed*
--improvement in thyroid (my TSH has always been 1.3-1.9 and finally in Dec 07 TSH=1.0 perfect)
--faster growth of hair, skin, nails (I'm constantly clipping my nails in winter -- whereas before they essentially stopped growing during these months)
--more alertness
--more mental acuity and communication skills (*shock* I'm bloggin?)
--more IQ points *ha haa* (the fish oil also plays an adjunctive role as my brain's 'high speed internet' connection!!)
--better sense of smell (less allergies)
--better sense of balance (I trip around and fall far less now)
--better reflexes
--better hearing...NOT... according to the hubby
--better vision...NOT (d/t occupational + extracurricular hazards)
--better in bed *chortle* (I mean I sleep better)



Jake said...

What confuses medical people with Vitamin D is the large difference between individuals in their ability to absorb Vitamin D.

Here is my journey in the past year to reach optimum Vitamin D levels.

4000 IU daily = 20ng/ml
6000 IU daily = 22ng/ml
10,000 IU daily = 50ng/ml
15,000 IU daily = 70ng/ml

The results for me were:

1. No more depression. Stopped taking Welburtrin after 13 years of use.

2. Systolic blood pressure drop of 9 points

3. No more gum disease, cavities and teeth breaking. All were a major problem for me before.

Dr. B G said...

WOW Jake! That is excellent.


Andrew said...

I don't know how much Vitamin D to supplement, or even what kind. Every time I've contemplated picking up some Vitamin D, there's always a few different kinds, and I get confused. What are you all using?

Dr. B G said...

I know what you mean!

Vitamin D can be sourced from cod liver oil but even the high potency brands don't have sufficient amounts to combat the deficiency that is apparently so widespread.

The brands that I've tried (I'll be posting later as well) are:
--NOW Vitamin D 400, 1000, 2000 and 5000 IU daily
--Carlson's Solar D Gems 4000 IU (though a patient told me they're on backorder)
--Costco's Nature's something dry tablet (I didn't like it)
--Nature's Blend 2000 IU dry tablets (at most drug stores)

Ones I haven't tried but are likely to be reputable: NSI brand 4000 IU capsules
--Liquid drops (highly concentrated) -- Anna at againstthegrain (blog) likes this

Dr. Davis prefers capsules because he finds that often tablets don't yield consistent blood results.

My experience is that everyone is uniquely different in absorption, metabolism, storage, activation, and elimination of vitamin D. Dr. Schwalfenberg has also noted in certain subpops vitamin D levels are lower due to higher activity of 24-hydroxylase the enzyme system which degrades vitamin D for disposal. It's genetic and often found in Indo-Asians (and probably anyone with significant familial osteoporosis +/- premature strokes/heart attacks; like certain Chinese Asians and other Asian ethnicities).

Just like plaque-tracking, blood level tracking via lab testing is important after starting vitamin D 6-8 wks later then periodically. Naturally, toxicity can cause the same dysregulation as deficiency (though apparently rare in the literature).

My experience is that the most common dosage for young-, mid- and older-aged men and women is 4000 IU daily. Those with sleep deprivation and/or high mental stress require more (eg, new moms, non-exercising 'worriers', high testosterone entrepeneurs, etc).

Sometimes it's highly variable so lab testing gives necessary feedback for appropriate dose adjustment and hopefully optimal clinical responses. Let us know how repletion goes! Kansas residents definitely require vitamin D in the winter months!


Anonymous said...

Dr. B. G.-
Thank you so much for this post. I am a 55 yr old female diagnosed with copd a while back and then had complete respiratory failure in Sept of 07. Hospitalized for a week and couldn't walk from the my be to my kitchen counter (about 15 ft) I began seeing research on lungs and vitamin d about 5 mos after my "episode" and began supplementing early this year. When I read your post I thought I was reading my bio. LOL. Of course I there are some diffences in our health histories but just about everything you say happened to you also happened to me.

One of the major factors for me is the muscle strength and balance. I hadn't been able to exercise and never felt like it but after about 3 months on the D I began a short exercise prog each day and I continue it to this day.

Every winter I would have bronchitis or the flu. Haven't had a bout since I started taking them and we've had three "outbreaks" in my school building since last Jan.

I can attribute some of my improvement to not smoking but not that much stuff would improve just from not smoking. I'm taking 10,000 per day and will continue to do so until summer when I can get out in the sun again.

Please contintue to write about this. It's made a tremendous difference in my life. I'll keep an eye on your blog. Thank you.

Debbie from Indiana

PS-Newsweek has a good article this morning on vitamin D:

Dr. B G said...

Thanks Debbie!

I luv that link!!! The Harvard doc does a great job at highlighting the impressive benefits including the asthma we both suffered from (I quit smoking too). That is a great article for patients to bring to their docs (in addition anything from TYP or HEARTSCANBLOG) and begin the over-neglected conversation about vitamin D and get tested.

I'm glad you feel so much better. I do believe scores of women are like us -- perhaps not as self aware of their bodies or are too busy to frankly notice. We're so cerebral and overthink and have too much mis-information in our multimedia heads.


dr. m.c. said...

so what are the sources of these high potency vit d pills? fish? corn syrup?

also does it make a difference that some high potency are only d3 (like "now")?

with many thanks for a super article


Dr. B G said...

Hi MC,

Most natural Vitamin D sources (D3 cholecalciferol, to be precise) are from typically seafood sources which is rich in Vitamin D -- fish liver, cod, halibut, shark, lanolin/animal-skin, etc.

If you are a vegetarian/vegan, it may be difficult for you to obtain. Mushrooms & seaweed have D2 which is 1/3 the potency of D3. Prescription D2 is synthetic (fake) and related to toxicity compared with D3. Yeast is another source of D2.

Hope that answers your questions?

I promise there will be more articles... had no idea this topic was so HHOOOTTT!!


dr. m.c. said...

Holick December 2007 issue of the Journal of Clinical Endocrinology & Metabolism did a comparison of D3 with D2 - i've finally refound it - and argues from the results that they are equally as effective as D3.

The circulating levels of 25-hydroxyvitamin D increased to the same extent in the groups that received 1,000 IU daily as vitamin D2, vitamin D3, or a combination of 500 IU vitamin D2 and 500 IU vitamin D3. The 25-hydroxyvitamin D3 levels did not change in the group that received 1,000 IU vitamin D2 daily. One thousand IU of vitamin D2 or vitamin D3 did not raise 25-hydroxyvitamin D levels in vitamin D deficient subjects above 30 ng/ml.
end quote

do you think the study is flawed in some way, then, that you say d2 is a third as effective as d3?

also there's a great interview with Holick where he talks about taking 10000IU's a day of vit d leading to vit d "intoxication" (p71).

not sure how long the sited study goes for that recommends the 15k.

anyway, on p75 He talks about the rational for the above studywhen the interviewer asks isn't the finding of D2 as equivalent to d3 at odds with earlier studies. Holick's says yes, and explains some issues with how those previous findings were derived.

would be interested in your take of why then you'd still say d2 = 1/3 d3?


Dr. B G said...

Hi mc,

The study is not flawed but likely many vitamin D studies, the dosing is insufficient. The researchers are groping in the dark and they are off by magnitudes of 10. With trying to get IRB (institutional review board) approval regarding human safety, this is often happens in the beginning.

Esp with pardigm shifts.

D2 being less potent is widely accepted. In fact, I have to go really back b/c I don't recall the studies. This the general

I'm not sure if Holick participates in outpatient management of vitamin D deficiency? That may explain a little bit. From what I have observed, D2 and D3 are not dose equivalents at all.

D2 is also associated with more toxicity and less ability to lower hyperparathyroidism. It is also likely to be less affective for heart disease, cardiovascular and endocrinological benefits.

Check these out:
Vieth 1998 Am J Clin Nut Vitamin D3 1.7x more potent than D2 (but still off)

Vieth R The Case Against Ergocalciferol (eg, Vitamin D2 fake/synthetic stuff)

I might have questions later for you too! KBs are great!


Dr. B G said...

Here's the article where D3 is THREE times more potent than synthetic D2.

J Clin Endocrinol Metab. 2004 Nov;89(11):5387-91.

Vitamin D2 is much less effective than vitamin D3 in humans.Armas LA, Hollis BW, Heaney RP.

Vitamins D(2) and D(3) are generally considered to be equivalent in humans. Nevertheless, physicians commonly report equivocal responses to seemingly large doses of the only high-dose calciferol (vitamin D(2)) available in the U.S. market.The relative potencies of vitamins D(2) and D(3) were evaluated by administering single doses of 50,000 IU of the respective calciferols to 20 healthy male volunteers, following the time course of serum vitamin D and 25-hydroxyvitamin D (25OHD) over a period of 28 d and measuring the area under the curve of the rise in 25OHD above baseline.The two calciferols produced similar rises in serum concentration of the administered vitamin, indicating equivalent absorption. Both produced similar initial rises in serum 25OHD over the first 3 d, but 25OHD continued to rise in the D(3)-treated subjects, peaking at 14 d, whereas serum 25OHD fell rapidly in the D(2)-treated subjects and was not different from baseline at 14 d. Area under the curve (AUC) to d 28 was 60.2 ng.d/ml (150.5 nmol.d/liter) for vitamin D(2) and 204.7 (511.8) for vitamin D(3) (P < 0.002). Calculated AUC(infinity) indicated an even greater differential, with the relative potencies for D(3):D(2) being 9.5:1.Vitamin D(2) potency is less than one third that of vitamin D(3). Physicians resorting to use of vitamin D(2) should be aware of its markedly lower potency and shorter duration of action relative to vitamin D(3).

PMID: 15531486