Originally published January 21 2008
It's Winter - Do You Know Where Your Vitamin D Is?
by Teri Lee Gruss
(NaturalNews) John Cannell, MD, Director of the Vitamin D Council and author of the Vitamin D Newsletter has looked at recent conflicting media coverage of the effects of vitamin D on cancer. The December 2007 issue of the newsletter addresses how studies have been interpreted and how biased interpretation can adversely affect public health policy and your health.
You can also read the latest studies that link vitamin D deficiency to risks for cancer and make your own independent conclusions.
According to Dr. Cannell, Dr. Lichtenfeld, spokesman for the American Cancer Society has indicated that Americans continue to wait for more randomized, control trials before addressing their vitamin D deficiencies, even though a large volume of epidemiology studies indicate that vitamin D deficiency is a common finding in people of all age groups around the world.
At the same time, after risk/benefit analysis the Canadian Cancer Society has advised all Canadians to take 1000 IU of vitamin D daily. The Food and Nutrition Board, that sets U.S. nutrient recommendations currently recommends 2000 IU of vitamin D per day as a safe upper limit dosage for anyone over one year old.
So why aren't U.S. public health organizations like the American Cancer Society willing to increase the recommendations for adequate intake of vitamin D, like the Canadian Cancer Society have done?
Currently the Food and Nutrition Board recommends adequate intake of vitamin D at 200 IU for infants to 50 year olds, 400 IU for 51 to 70 year olds and 600 IU for those 71 and older. These recommendations persist, even with the current established safe upper limit dose of 2000 IU daily, even for one year olds. Is it good for your health to stick with these outdated government recommendations?
In the book Nutrition and Bone Health, Michael Holick, PhD, MD of Boston University and Bess Dawson Hughes, MD, Professor of Medicine at Tufts University discuss current vitamin D recommendations and the most accurate vitamin D blood test.
U.S. recommendations for adequate intake of vitamin D are based on research available prior to 1996, about 11 years ago! Also, current recommendations in the U.S. are based on the effects of vitamin D on bone health and calcium absorption but do not reflect, or even acknowledge the other vital biological functions of vitamin D, including its role in cancer prevention.
U.S. recommendations for vitamin D intake do not take into account the function of vitamin D in the regulation of blood pressure, insulin production, regulation of immune function and cell growth.
One very important step that you can take towards improving your own health is to ask your physician for a vitamin D test. The test is called a 25 hydroxy(OH)2 D blood test. It is inexpensive and the information provided is invaluable, especially during the winter months when your vitamin D levels may drop significantly with decreased exposure to sunlight, particularly if you live in northern regions of the country.
If your physician doesn't think that it is important to assess your vitamin D status, it may be wise to find a physician that understands the current scientific evidence regarding the importance of vitamin D to your health.
Or, you can directly order your own vitamin D blood test. Direct Labs is one source for screening tests as is the Life Extension Foundation. A requisition form is sent directly to you and you have your blood drawn at a lab where you live. In many cities you can have your blood sample taken at a convenient Lab Corp location or even at the lab that your doctor uses.
Vitamin D exists in several forms in the human body. Sometimes physicians order a test called the 1,25 (OH)2 D test. This is the most potent or active form of vitamin D in the human body, but according to Dr. Holick and Dr. Dawson Hughes, measuring 25(OH)2 D is a better blood test for assessing vitamin D status and say, frankly that the 1,25(OH)2 D blood test is "useless" in the assessment of vitamin D status.
Vitamin D3 derived from sunlight is called cholecalciferol. It is activated in the liver to 25(OH)2 D, also called calcidiol. From there, it enters blood circulation and travels to tissues, including the kidneys, where enzymes activate it to its most biologically active form, 1,25(OH)2 D, also called calcitriol.
As discussed in Dr. Holick and Dr. Dawson-Hughes' text, blood levels of this later form, 1,25(OH)2 D can be normal or even elevated at the same time that a person has vitamin D deficiency. Why? Because a vitamin D deficiency can cause a condition called hyperparathyroidism.
The human body, in an amazing attempt to normalize vitamin D concentrations at a cellular level, increases production of PTH (parathyroid hormone) that signals the kidneys to increase production of 1,25(OH)2 D.
If this sounds confusing, it can be! At least the first time you read it. Vitamin D is really a "prohormone" and is activated like other hormones in the body, through a process of hormonal signaling.
For the purpose of nutritional assessment of vitamin D status, make sure you request the 25(OH)2 D test, not the 1,25(OH)2 D test.
Dr. Holick,an eminent international vitamin D researcher recommends that lab reference ranges for vitamin D blood tests be raised. He has suggested an "optimal" healthy range of 25 (OH)2 D at 45-50 ng/ml. Most labs currently use a range of 20-56 ng/ml as "normal".
According to Holick, "Any levels below 20 ng/ml are considered deficiency states and will increase your risk of breast and prostate cancer and automimmune diseases like MS and rheumatoid arthritis".
And, by all means, read Dr. Cannell's December issue of the Vitamin D Council Newsletter. The Vitamin D Council website is an excellent source for up-to-date research regarding the benefits of maintaining healthy vitamin D levels.
Nutrition and Bone Health, Holick and Dawson-Hughes, pp.425-429
Holick, MF, Calcium and Vitamin D, Diagnostics and Therapeutics, Clin Lab Med, 2000 Se;20(3):569-90
The Vitamin D Newsletter, December, 2007 (Reprinted with permission)
Does vitamin D prevent cancer? If it does, will doctors who ignore the research end up with blood on their hands? The press makes it easy for doctors to believe what they want to believe. Below are six stories about the same scientific study; read the six different headlines. According to you're prior beliefs, you can choose the story you want to believe and read that one. Don't feel bad, we all do it. As Walter Lippman once said, "We do not see and then believe, we believe and then we see."
* Vitamin D cuts colon cancer death risk
* Study Finds No Connection Between Vitamin D And Overall Cancer Deaths
* Vitamin D protects against colorectal cancer
* Vitamin D May Not Cut Cancer Deaths
* Vitamin D protects against colorectal cancer
* Scientists advise a vitamin D downgrade as there is no real proof...
Another option is to read the study yourself.
Freedman DM, et al. Prospective Study of Serum Vitamin D and Cancer Mortality in the United States. J Natl Cancer Inst. 2007 Oct 30; [Epub ahead of print]
What Dr. Freedman actually discovered is that when you take a very large group of people (16,818), some as young as seventeen, measure their vitamin D levels, and then wait about ten years to see who dies from cancer, you find 536 die and that a vitamin D level from ten years earlier is not a good predictor of who will die from cancer. However, even a level drawn ten years earlier predicted that those with the lowest level were four times more likely to die from colon cancer, suggesting, as Ed Giovannucci has, that colon cancer may be exquisitely sensitive to vitamin D. Furthermore, 28 women got breast cancer, 20 in the group with the lowest vitamin D level but only 8 in the highest. The breast cancer findings were not statistically significant - even during a very long breast cancer awareness month - but can you imagine what critics at the American Cancer Society would be telling women if the numbers were reversed, if the 20 women who got breast cancer were in the high vitamin D group?
Another large epidemiological study appeared about breast cancer the very next day. This time, the press passed on the story and the American Cancer Society was mum, no editorials by Dr. Lichtenfeld, their spokesman, in spite of breast cancer awareness month.
Abbas S, et al. Serum 25-hydroxyvitamin D and risk of postmenopausal breast cancer - results of a large case-control study. Carcinogenesis. 2007 Oct 31; [Epub ahead of print]
In the above study, 1,394 women with breast cancer were case-controlled with a similar number of women without breast cancer. The women with breast cancer were three times more likely to have low vitamin D levels. That is a lot of women who may be dying during next year's breast cancer awareness month.
Both of the above studies were epidemiological, not randomized controlled trials. Of course a randomized controlled trial has already shown a 60% reduction in internal cancers in women taking even a modest 1,100 IU per day of vitamin D.
Lappe JM, et al. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007 Jun;85(6):1586-91.
What is interesting is the difference in the response of the Canadian Cancer Society and the American Cancer Society. The Canadian Cancer Society has advised all Canadians to take 1,000 IU per day - not enough but a good first step - and for immediate additional large scale clinical trials. The Canadians simply performed a risk/benefit analysis. What is the risk of treating vitamin D deficiency versus what are the potential benefits? They quote the American Food and Nutrition Board, which says 2,000 IU/day is safe for anyone over the age of one to take, on their own, without being under the care of a physician. If there is little or no risk, then the next question is what are the potential benefits of treating vitamin D deficiency? This is not quantum mechanics.
Cancer society calls for major vitamin D trial
The Canadians acted because the Canadian government knows it could save billions of dollars by treating vitamin D deficiency.
Vitamin D Deficiency Drains $9 billion From Canadian Health Care
If wide spread treatment of vitamin D deficiency became the rule, ask yourself, "Who would be helped and who would be hurt." First ask yourself that question about Canada and then about the USA. Remember, in Canada, the government directly pays for its citizen's health insurance; in the USA, private insurance is the norm. In Canada, the government is realizing they could save billions if vitamin D deficiencies were treated. In the USA, a large segment of the medical industry would be hurt, some anti-cancer drug manufacturers would have to close their doors, thousands of patents would become worthless, lucrative consulting contracts between industry and cancer researchers would dry up.
Both Canadians and Americans are shocked to think their doctors care about money and are in the illness business. In some ways people think of their doctors like they do their local public schools. They know medicine is a business and know doctors do things for money but they don't think their own doctors do. Likewise they think public schools are in bad shape but think their local schools are above average. They think their doctor is above average, like their "Lake Woebegone" kids.
The Lake Woebegone Effect
The fact is that doctors, hospitals, regional cancer centers, and the cancer drug manufacturers are all in business to make money and all of these businesses make money off the sick, not off the well. Just a fact, but, as Aldous Huxley once observed, "Facts do not cease to exist because they are ignored."
Vitamin D will save the Canadian government enormous amounts of money but will cause widespread economic disruption in the USA. Do the physicians leading the American Cancer Society have strong economic ties to the cancer industry in the form of patents, stock options, and consulting fees? If so, what do you expect them to do? What would you do? It's simple. You would believe what you have to believe, what you need to believe, that is, anything with the word "vitamin" in it is simply the latest Laetrile. Look to Canada, not the USA, to lead the way.
Vitamin D may fight cancer
What about American physicians? They are apparently waiting for the American trial lawyers to smell a tort. After all, the case is quite simple. Doctor, did you advise Mrs. Jones to avoid the sun? Doctor, did you tell her the sun is the source of 90% of circulating stores of vitamin D? Doctor, did you prescribe vitamin D to make up for what the sun would not be making? Doctor, did you measure her vitamin D levels? So you had no way of knowing if your sun-avoidance advice resulted in vitamin D deficiency? Doctor, do you know our expert tested her vitamin D level and it was less than 20? Doctor, did you tell her about any of the studies indicating vitamin D deficiency causes cancer? Doctor, did you know Mrs. Jones has terminal breast cancer and will be leaving behind a loving husband and two young children?
And what about the American Cancer Society? Dr. Lichtenfeld, their spokesman, quickly gave his opinion; from what I can tell the first time he ever commented on a vitamin D study. That is, he has ignored the hundreds of positive epidemiological studies, ignored the incredible randomized controlled trial, but he jumped on this one:
Maybe Vitamin D Isn't The Answer After All
Dr. Lichtenfeld, implied the Canadian Cancer Society has acted precipitously in recommending that all Canadians take 1,000 IU of vitamin D daily. He implied that Americans should placidly wait until more randomized controlled trials, such as Lappe JM, et al (above), accumulate before they address their vitamin D deficiency. That is, nothing should be done until more randomized controlled trials prove vitamin D prevents cancer, one randomized controlled trial is not enough; epidemiological studies are not enough, animal studies are not enough, multiple anti-cancer mechanisms of action are not enough. If that is his position, I challenge him to point to one human randomized controlled trial that proves smoking is dangerous.
If he cannot, then he must admit that the American Cancer Society's position on smoking is entirely derived from epidemiological studies, animal studies, and a demonstrable mechanism of action, not on human randomized controlled trials. Vitamin D not only has hundreds of epidemiological studies, thousand of animal studies, and at least four anti-cancer mechanisms of action, vitamin D deficiency has something smoking does not have, it has a high quality randomized controlled trial. If future randomized controlled trials fail to show vitamin D prevents cancer - and Dr. Lichtenfeld better hope they do - he can have the satisfaction of saying "I told you so." If future randomized controlled trials confirm vitamin D prevents cancer, then he needs to look at his hands, the red he sees is the blood of needless cancer deaths.
John Cannell, MD
The Vitamin D Council
9100 San Gregorio Road
Atascadero, CA 93422
About the authorTeri Lee Gruss, MS Human Nutrition
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