Sunday, May 24, 2009

Vitamin D: Disease Prevention

Image: courtesy of (and

Cancer and Vitamin D
Few prospective vitamin D trials exist in the literature in humans for cancer. Our best data exists as epidemiological observations. The above wonderful graphic depiction of the relationship between disease prevention and serum concentrations of vitamin D [25OHD] was complied by Dr. Davis attended a conference last year and learned that the NIH budget for studying cancer and vitamin D will be increased by $200 million. Heartening to know that funding is being put to actually good use. Cancer has now superceded heart disease to take the #1 spot for mortality in the U.S. Hopefully we'll learn more in a decade or a two! I believe it is difficult to expect Pharma or other large deep-pocketed research giants (backed by lobbyists) to fund a trial where the preventive treatment (OTC at Trader Joe's or Walmart or Target or Costco or costs as little as $2 per month and prevents a $150,000+++ cancer treatment paid for by Medicare and most insurance companies.

In the meantime...can you afford to wait for the research results?

Hopefully NIH scientists will 'get it right'... and...
(1) Use the therapeutic doses of vitamin D 4000-8000 IU daily (not 400-800 IU daily which are literally doses recommended for babies, infants and toddlers by the Academy of Pediatrics),
(2) Use vitamin D3 (not synthetic D2 which is not metabolized well by majority of the globe, esp Indo-Asians, and is linked to toxicity compared to natural D3)
(3) Use 'tracking' of [25OHD] blood concentrations
(4) Use results where [25OHD] is greater than 50 ng/ml (not just greater than 30 ng/ml... see above graph). [25OHD] of 30 ng/ml accomplishes nearly N O T H I N G... except rickets prevention greater than 99%.

Don't you deserve greater than 35%, 83%, 17%, 60%, 18%, 66%, 50%, 72%, 54%, 30%, 49%, 37% prevention, respectively for the cancers and conditions listed above?

And your family and friends?

Vitamin D, Safety and Dosing
Dosing depends on a variety of factors. You really don't know if you have the right dose unless you check 4-6 wks after initiating supplementation. Everyone is uniquely different and so are the enzymes which activate and de-activate vitamin D and its derivatives, the skin protective melanin/pigmentation which blocks excessive activation, how much time spent indoors, how much makeup/sunscreen/clothes are worn, etc.

Dr. Cannell, Dr. Davis and other vitamin D experts advise starting at vitamin D3 5,000 IU daily in the morning/daytime if you receive no sunlight or live in an area devoid of UVB radiation (~half of the year nearly zero UVB above the 37th latitude).

The below graph is from a prominent vitamin D researcher, Dr. Vieth, in Canada where vitamin D supplementation is nearly mandatory (Vieth R 1999). I've superimposed the dose I take to achieve 60 - 70 ng/ml, vitamin D 5,000 IU daily. In winter I take 8,000 to 10,000 IU daily which is more similar to the dosing curve Vieth has determined in his clinical research.

For U.S. standard lab values, to convert nmol/L to ng/ml, divide by 2.5.

Dr. Vieth writes that "The clinical trial evidence shows that a prolonged intake of 250 mug (10,000 IU)/d of vitamin D(3) is likely to pose no risk of adverse effects in almost all individuals in the general population; this meets the criteria for a tolerable upper intake level (Vieth R 2007)."

Dose response for vitamin D intake versus final serum 25-hydroxyvitamin D [25(OH)D] concentration reported. Circles indicate group means from Tables 4 and 5. Points indicated by "X" represent single values from Table 5 for people reported as intoxicated with vitamin D. The arrow indicates the lowest dose reported as causing hypercalcemia, but which is an outlier because vitamin D was given as a single dose of 7500 µg (300000 IU)/mo, instead of 250 µg (10000 IU)/d (77). If authors reported 25(OH)D for several time points, only the final serum 25(OH)D is shown in the figure. The line representing the dose response passes through the points that represent group data.

Low wintertime vitamin D levels in a sample of healthy young adults of diverse ancestry living in the Toronto area: associations with vitamin D intake and skin pigmentation.
Gozdzik A, Barta JL, Wu H, Wagner D, Cole DE, Vieth R, Whiting S, Parra EJ.
BMC Public Health. 2008 Sep 26;8:336.

Vitamin D from dietary intake and sunlight exposure and the risk of hormone-receptor-defined breast cancer.
Blackmore KM, Lesosky M, Barnett H, Raboud JM, Vieth R, Knight JA.
Am J Epidemiol. 2008 Oct 15;168(8):915-24. Epub 2008 Aug 27.

Evidence for genetic regulation of vitamin D status in twins with multiple sclerosis.
Orton SM, Morris AP, Herrera BM, Ramagopalan SV, Lincoln MR, Chao MJ, Vieth R, Sadovnick AD, Ebers GC.
Am J Clin Nutr. 2008 Aug;88(2):441-7.

Vitamin D toxicity, policy, and science.
Vieth R.
J Bone Miner Res. 2007 Dec;22 Suppl 2:V64-8. Review.

Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety.
Vieth R. PDF here.
Am J Clin Nutr. 1999 May;69(5):842-56. Review.


Anna said...

D-lightful post!

Last week I had my annual "well woman" visit with the gyn Nurse Practitioner. She noted my recent 25 (OH)D level of 68 ng/mL, which she approved of, as well as my daily dose of 5000iU to achieve it.

She said that about 80% of her patients are deficient (<30 ng/ml) when first tested (and that's in "sunny" San Diego County). But women here, esp along the coastal communities, are very sun-averse these days.

Dr. B G said...

Hi Anna!

I was just thinking I should've named the past D-sease Prevention *haa*

That is a great lab value! I wonder what % of patients are truly deficient (<60ng/ml) in San Diego, one of the most beautiful, sunniest areas on earth?


Anna said...

I think the rate of deficiency and insufficiency in San Diego is probably quite high.

In our coastal suburban region, every day I see behaviors and lifestyle habits throughout the community that are guaranteed to contribute to Vitamin D deficiency and insufficiency.

I don't argue with most of the protective clothing that has become more common, as I think covering up is a preferable form of sun protection compared to constantly applying SPF potions to the skin or always staying out of the sun, but I wonder about excessive levels of protection that result in long-term Vit D deficiency and insufficiency. What will the health of these extra pale kids be like 20-40-60 years from now?

Dr. B G said...


I see damage from gluten, vitamin D deficiency and omega-3 deficiencies E V E R Y D A Y.


Fitnatic said...

Dr., in the comments to your previous post, you made a statement that you might be allergic (weight gain) to saturated fat concluding that your ancestors might have evolved in a tropical area.
Could you further expound on the correlation?

Dr. B G said...

Hey P,

I first had that thought when I was reading Udo Erasmus book on fats (which is an exc reference but he's a little down on Sat Fats and fish oil). He mentioned something about PUFAs in the diet of northern v. tropical dwelling humans. I think he was on to something.

Dairy fat -- I can't do a lot of it. Obviously dairy is not Paleo. If I drink 1/4 to 1/2-c cream daily, I get FAT really FAST (despite low carb or ketotic). However, VCO (virgin coconut oil) no problem at all whatsoever. In fact VCO has raised my HDLs from 89 to 104 mg/dl. Since I still am a total hypocrite and do 1-2 Tbs cream (non-grass-raised) a couple x per wk in my coffee, I'm not the best Paleo specimen *haa* Maybe it's the PUFAs in the cream, interleukins, the hormones BGH, or antibiotics. I dunno what it is.

Hope that helps and good luck on your journey! You have cool blog!


Marisa said...

Just a quick comment to your comment - the most saturated of saturated fats is: coconut oil. Not animal fat. Saturated fats have been so unfairly demonized; all naturally-occuring oils contain wonderful and benefitial compounds such as lauric acid (MCT in coconut oil), butyric acid (found in butter), conjugated linoleic acid (fat in grass-fed beef). These compounds are anti-fungal, anti-microbial, they kill cancer cells, tumors, they increase muscle mass, prevent achy joints, prevent calcification of the pineal gland (wulzen factor), and many more benefits too numerous to list!!!

The second comment I wanted to make is this: heavy cream contains additives that you may be reacting to that has nothing to do with the dairy product. I have read that they don't list it, but it's there (to keep it stable). Carrageenan is in it, which isn't listed, and I don't know what else. Something to keep in mind ...

Dr. B G said...


Thanks for your thoughtful comments. Coconut oil is fantastic stuff! :)
--raising HDLs
--wrinkle preventing
--antimicrobial/fungal etc
--thyroid boosting

I need to give up cream someday... don't know when!


Ken said...

68 ng/mL,- (to convert fron Mickey Mouse units - times 2.5)

That's 17O nmol/L.

You might want to take a look at this -
Mad dogs and ....

Dr. B G said...


I'm not sure what your point is? Pls clarify?

Thank you,

. said...

Great book from a cholesterol skeptic:

Vitamin D and Cholesterol: The Importance of the Sun [Hardcover], David S. Grimes

Dr. B G said...


I love LOVE LOVE Grimes like I love you :)

Hugs and kisses,