VITAMIN D IN THE NEWS

[jcannell]

VITAMIN D IN THE NEWS 

The Vitamin D Newsletter
January 24, 2003
The Vitamin D Council
9100 San Gregorio Road
Atascadero, CA 93422
805 462-8129
http://www.cholecalciferol-council.com
address@hidden

 
This is a periodic newsletter concerning vitamin D published by the Vitamin D 
Council, a non-profit corporation described at the end of this newsletter. Both 
the content and tone of this newsletter is the product of the Vitamin D Council 
and not of any of the scientists listed below.  Any errors are our 
responsibility and we encourage readers to alert us to any mistakes. If any 
critic can find a substantial error in anything we have printed, we will bring 
that error to the attention of our readers, correct it, and confer a free 
lifetime subscription to the Newsletter upon the critic.  We are particularly 
interested in not overstating our case.  

All we are asking is for the medical establishment to listen to what the 
vitamin D scientists are saying: vitamin D deficiency is widespread and that 
deficiency appears to play a significant role (the extent currently 
undetermined) in many of the multifactorial chronic diseases that afflict 
modern society.   You are on the our mailing list because you: have a research 
interest, a general academic interest or a clinical interest in vitamin D; are 
a research scientist, a professional health or science writer, a health care 
provider; or an employee or associate of the NIH, CDC or the National 
Academies.  You have been selected to receive this publication free for the 
near future. 
 
To unsubscribe from The Vitamin D Council Newsletter, just click on the 
following link and follow instructions:   
http://www.cholecalciferol-council.com/cgi-bin/dada/mail.cgi
 

VITAMIN D IS IN THE NEWS.  CONSIDER TODAY’S INDEPENDENT NEWSPAPER, ONE OF THE 
BIGGEST NEWSPAPERS IN THE UK.

http://news.independent.co.uk/uk/health/story.jsp?story=483268

IN THE LAST SEVERAL YEARS, MAINSTREAM SCIENTISTS AT MAJOR UNIVERSITIES HAVE 
REPORTED AN INCREDIBLE VARIETY OF ILLNESSES ARE ASSOCIATED WITH INADEQUATE 
VITAMIN D INTAKE. CONSIDER THE FOLLOWING STORIES REPORTED BY WEBMD.

VITAMIN D MAY PREVENT MS

http://my.webmd.com/content/article/79/96225.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d

VITAMIN D MAY PREVENT ARTHRITIS

http://my.webmd.com/content/article/79/96161.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d

VITAMIN D HAS HEART BENEFITS

http://my.webmd.com/content/article/19/1689_52736.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d

LACK OF VITAMIN D LINKED TO PAIN

http://my.webmd.com/content/article/78/95751.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d

DON'T LET VITAMIN D LEVEL DIP IF YOU HAVE BOWEL DISEASE

http://my.webmd.com/content/article/23/1728_56741.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d

VITAMIN D SUPPLEMENTS MAY PROTECT AGAINST DIABETES IN KIDS

http://my.webmd.com/content/article/35/1728_92680.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d

COULD TOO LITTLE VITAMIN D CAUSE CANCER?

http://my.webmd.com/content/article/77/95337.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d

VITAMIN D AND HYPERPARATHYROIDISM

http://my.webmd.com/content/article/22/1728_56216.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d

VITAMIN D KEY TO COLON CANCER

http://my.webmd.com/content/article/16/1671_53266.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d

VITAMIN D PREVENTS TOOTH LOSS

http://my.webmd.com/content/article/28/1728_61745.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d

VITAMIN D MAY ALLOW FOR LOWER DOSES OF STEROIDS

http://my.webmd.com/content/article/22/1728_55456.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d

Everything from chronic pain, to diabetes, arthritis, bowel disease, multiple 
sclerosis, cancer and tooth loss!  Of course there are even more conditions 
associated with vitamin D deficiency as readers of this newsletter know.  The 
problem is that other than osteoporosis, osteomalacia and rickets, the quality 
of the causation evidence varies from little to suggestive.  However, one thing 
most Americans seem to believe is that sunlight must be avoided for it causes 
skin cancer, especially malignant melanoma.  We decided to give a little quiz 
about the subject.

1.  Imagine that Andrew C. von Eschenbach, M.D., the director of the National 
Cancer Institute (NCI), visited his dermatologist who examined him and 
diagnosed a small squamous cell cancer on his nose.  His dermatologist, who 
noted that Dr. von Eschenbach had the quaint custom of regularly exposing his 
body to short courses of noonday sunlight on the roof of the National Library 
of Medicine, advised Dr. von Eschenbach to now totally avoid the sun.  As Dr. 
von Eschenbach has read every scientific article ever written on cancer, his 
reaction was:

A.  He thanked his dermatologist but knowing the prognosis is grim for those 
who develop squamous cell skin cancers, went home and wrote a will.

B.  He immediately arranged to have a complete examination by an internist as 
Dr. von Eschenbach knows his chances of developing internal squamous cell 
cancers is much higher after being diagnosed with a squamous cell skin cancer.

C.  He knew he must now avoid the sun entirely, so he bought cases of sunblock 
and lots of clothes that would totally protect his skin.  He vowed to never let 
another ultraviolet ray of sunlight ever strike his unprotected skin.

D.  He jumped up, smiled broadly, hugged his dermatologist, arranged to have 
the skin cancer removed, put some unblock on his face and hands, took of his 
shirt and changed into shorts for the walk to his car and then drove home to 
tell his loved ones the good news.

The correct answer is D.  Dr. von Eschenbach knows that virtually all squamous 
cell skin cancers are easily treated when caught early and that fewer than 600 
Americans die every year from squamous cell skin cancers compared to tens of 
thousands who may be dying from internal malignancies induced by vitamin D 
deficiency. Furthermore, he knows the strong inverse relationship between 
squamous cell skin cancers and the subsequent development of internal cancers 
has been known more than sixty years.  He also knows that inverse relationship 
led to one of the first modern theories of cancer (that squamous cell skin 
cancers conferred immunity against various visceral cancers) which is better 
explained by sun exposure increasing both squamous cell skin cancers and 
calcidiol levels.  Furthermore, he knows that the inverse association between 
sun-exposure and several common internal malignancies is robust and has been 
documented repeatedly. Furthermore, he knows that one of the best things he can 
do to reduce his chance of getting up to 13 different serious internal cancers 
is to continue to maintain his healthful levels of serum calcidiol [25(OH) D] 
by consistent safe sun exposure.  If he preferred to totally avoid the sun and 
oily fish, relying on vitamin D supplements instead, he would need to take 
between 3,000 to 5,000 IU of cholecalciferol a day to maintain a 25 (OH)D level 
above 40 ng/ml.

References: 
Apperly FL. The relation of solar radiation to cancer mortality in North 
America. Cancer Res 1941; 1:191-5
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2263572&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1536921&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7721513&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1451068&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10350434&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2572900&dopt=Abstract

2.  The latest evidence suggests 21,000 Americans die every year from internal 
malignancies associated with inadequate UVB exposure?

A.  True

B.  False

True.  Actually Grant feels the number below is an underestimate and is coming 
out with an even more frightening estimate.

References: 
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11920550&dopt=Abstract

3. As malignant melanoma is caused by chronic sun exposure, the incidence of 
malignant melanoma is more common on the hands, is more common in those who 
work outdoors and is less common in those who use sunscreen. 

A.  True

B.  False

False.  Although malignant melanoma does increase with age, the increase is not 
dramatic as it is with the skin cancer most clearly associated with chronic 
sun-exposure, squamous cell skin cancer.  And, unlike squamous cell carcinoma, 
malignant melanoma is most common on relatively less exposed areas (backs in 
men and upper legs in women), is less common in outdoor workers than indoor 
ones and evidence to date does not show regular sunscreen use reduces its 
incidence. Instead of being caused by chronic sun-exposure, malignant melanoma 
is a multifactorial disease, the sun-exposure component of which appears to be 
best explained by repeated intermittent intense exposure (sunburn) in a 
population that usually avoids the sun (vitamin D deficient population).  

References: 
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9766557&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10699940&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3179192&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3988369&dopt=Abstract

4. For many years, the regular use of sunblock may have actually increased the 
incidence of melanoma?

A.  True

B.  False 

True.  Until a few years ago, sunblock usually blocked the burning (and vitamin 
D producing) UVB while allowing the more deeply penetrating, UVA.  Thus, they 
may have contributed to the rising incidence of malignant melanoma by allowing 
users to stay in the sun for hours without burning, while their skin soaked up 
the highly penetrating UVA radiation.  The best sunlight recommendations to 
prevent malignant melanoma may turn out to be to regularly expose your entire 
unsunblocked skin to very short periods (1/3 the time it takes for your skin to 
begin to redden) of direct noonday sunlight during the correct season of the 
year being careful to never let your skin get red or burn. 

References: 
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14678916&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9335442&dopt=Abstract

5.  Pretend that Kenneth, Director of the National Institute of Environmental 
Health Sciences, was asked if the American Academy of Dermatology (AAD) 
recommendations to totally avoid sunlight may have helped cause the rising 
incidence of melanoma and other diseases over the last 20 years by contributing 
to the current pandemic of vitamin D deficiency.  What should his answer be?

A.  Yes

B. No

Yes.  The American Academy of Dermatology press releases and spokesmen 
(http://www.aad.org/PressReleases/VitD_Sunshine.html) are particularly 
misinformed about vitamin D and appear to be giving information that increase 
the risks of developing a multitude of vitamin D deficiency related illness 
(including hypertension, heart disease, cancer, autoimmune disease, diabetes, 
depression, and, perhaps, even malignant melanoma).  Raymond L. Cornelison Jr., 
MD, President of the American Academy of Dermatology said, “ People who 
practice proper sun protection and are concerned that they are not getting 
enough vitamin D should either take a multivitamin or drink a few glasses of 
vitamin D fortified milk every day.  The dangers of exposing oneself to 
carcinogenic UV light from the sun, even for a few minutes, are firmly 
established, particularly since dietary intake of vitamin D can completely and 
easily fulfill our needs.”   

Dr. Cornelison and the AAD are putting their member dermatologists at risk for 
future malpractice liability with such incompetent advice.  When dermatologists 
assume control of the vitamin D system by recommending their patients terminate 
sun-exposure, they are required to ensure their patients have an adequate 
vitamin D status and that can only be assured by 25(OH) D (calcidiol) levels.  
Dr. Cornelison seems to be unaware that diet, without sunlight, can rarely 
supply adequate vitamin D and that one multivitamin (400 IU of vitamin D) a 
day, without sunlight, will actually ensure vitamin D deficiency.  

Just like an anesthesiologist, who assumes responsibility the airway on the 
patient she intubates, dermatologists who tell patients to totally avoid the 
sun, assume responsibility for their patient’s vitamin D system.  A number of 
academic dermatologists have said just that.  See if you can pick out the 
following quote in the two references listed below:  “it would seem mandatory 
to ensure an adequate vitamin D3 status if sun exposure were seriously 
curtailed, certainly in relation to carcinoma of breast, prostate and colon and 
probably also malignant melanoma.”  Coming from an academic dermatology center, 
it sounds like the kind of statement that juries take into account when trying 
to decide the applicable Standards of Care.

References: 
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12174089&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12720576&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12520530&dopt=Abstract

Humans evolved naked in the sun and have lived most of our time on earth within 
30 degrees of the equator.  Clothes are a recent addition,  as are the vitamin 
D reducing effects of cities, indoor work, automobiles and sunblock.  We will 
ask one more question.

The majority of Americans have 25(OH)D (calcidiol) levels most similar to which 
of the following groups:

A.  Old World, non-human primates living in the wild.

B.  New World non-human primates living in the wild.

C.  Modern day agricultural humans living near the equator.

D.  Modern day humans spending some of their time in a natural state 
(lifeguards).

E.  Lab rats.

You guessed it!

THE VITAMIN D SCIENTISTS LISTED BELOW ARE WRITING AND SPEAKING OUT ABOUT THE 
PROBLEM OF VITAMIN D DEFICIENCY.  ALL ARE WILLING TO SPEAK WITH THE PRESS.  
NONE ARE MEMBERS OF THE VITAMIN D COUNCIL.

William Grant, PhD
(Epidemiology)
12 Sir Francis Wyatt Place
Newport News, VA 23606-3660
Phone:  (757) 599-9811
Email: address@hidden

Robert Heaney, MD
Osteoporosis Research Center
Department of Medicine
Creighton University Medical Center
Omaha, NE 68131
Phone: (402) 280-4029
Email: address@hidden

Michael Holick, PhD, MD
Vitamin D Laboratory
Department of Medicine
Boston University Medical Center
715 Albany St. M-1022
Boston, MA 02118
Phone (617) 638-4545
Fax 617-638-8882
Email: address@hidden

Bruce Hollis, PhD
Departments of Pediatrics
Medical University of South Carolina
171 Ashley Ave.
Charleston, SC 29425
Phone (843) 792-6854
Fax (843)792-8801
Email: address@hidden

Christel Lamberg-Allardt, PhD
University of Helsinki,
Department of Applied Chemistry and Microbiology
P.O.Box 27, FIN-00014 
University of Helsinki
Finland
Phone: (358) 9-1-915-8266
Fax: (358) 9-1-915-8475
Email: address@hidden

Tony Norman, PhD
Department of Biochemistry
Room 5456 Boyce Hall
University of California
Riverside, CA 92521
Phone:  (909) 787-4777
Fax:    (909) 787-4784
Email: address@hidden

Reinhold Vieth, PhD
Pathology and Laboratory Medicine
Mount Sinai Hospital
600 University Ave.
Toronto, Ontario, Canada, M5G 1X5
Phone (416) 586-5920
Fax (416) 586-8628
Email: address@hidden


ABOUT VITAMIN D:

Vitamin D is a vital nutrient that is unique, both in terms of its physiology 
and because humans rely on both endogenous skin production and exogenous 
sources to meet biological requirements.  Vitamin D is commercially available 
as vitamin D2, (ergocalciferol) made from plant products, and vitamin D3, 
(cholecalciferol) made from animal products. Cholecalciferol is also made 
naturally in the skin by the action of a specific wavelength of ultraviolet 
light (UVB) interacting with precholesterol.  Cholecalciferol is then 
transported to the liver and turned into calcidiol [(25-hydroxyvitamin D].  
Recent evidence indicates calcidiol [(25-hydroxyvitamin D] has steroid hormone 
functionality.  In turn, the calcidiol [25-hydroxyvitamin D] is transported to 
the kidney and transformed into a more potent steroid, calcitriol 
[1,25-dihydroxyvitamin D], which is excreted into the blood to help regulate 
calcium in the body.  This is the main endocrine function of vitamin D.

Meanwhile, many tissues other than the kidney turn calcidiol [25-hydroxyvitamin 
D] into calcitriol [1,25-dihydroxyvitamin D].  Calcitriol 
[1,25-dihydroxyvitamin D], and perhaps calcidiol [25-hydroxyvitamin D], help 
regulate gene expression locally; this is the newly discovered autocrine 
(inside the cell) and paracrine (surrounding the cell) functions of vitamin D.  
This autocrine and paracrine function is impaired in vitamin D deficient 
subjects.  All studies show many Americans are vitamin D deficient, especially 
Blacks, where the problem is pandemic.  This use of calcitriol (and perhaps 
calcidiol) by other tissues as an autocrine and paracrine hormone is a 
relatively new discovery that explains its role in human development as well as 
the many health benefits of vitamin D in other illnesses such as diabetes, 
hypertension, heart disease, autoimmune illness, at least 13 different cancers 
and, perhaps, some mental illness.

The single most important scientific fact about vitamin D is that young adult 
Whites make about twenty thousand units of cholecalciferol in their skin within 
minutes of whole-body, summer-sun exposure.  This is one-hundred times the 
Adequate Intake (AI) and five times the toxicity maximums (Lowest Observed 
Adverse Effects Level or LOAEL) recommended by the Institute of Medicine (IOM) 
for young adults.  Therefore, many Americans greatly exceed the IOM’s safety 
recommendations by simply spending a few minutes outside in their swimming 
suits! This extraordinary rate of natural vitamin D production in the 
skin(20,000 IU) leading to the production of potent endocrine, paracrine and 
autocrine steroid hormones leads one (as T.S. Eliot once said), “to an 
overwhelming question.”  Why did Nature design such a complex steroid system 
reliant on rapid and bountiful production of cholecalciferol in the skin?  
Answer,” Probably for a very good reason.”

Because low calcidiol [25-hydroxyvitamin D] levels (< 35 ng/ml) are associated 
with so many chronic illnesses, calcidiol [25-hydroxyvitamin D] levels are an 
important part of any laboratory health evaluation and should be routinely 
checked by physicians.  Holick recommends they be checked every year, 
preferably in the fall.  We recommend they be obtained twice a year, once in 
late October and again in early April, depending on latitude, in order to 
obtain both peak and valley levels. Unfortunately, few physicians are aware of 
the vitamin D deficiency pandemic, so virtually no patients have their levels 
checked.  Consequently, perhaps as many as 70% of the U.S. population has 
calcidiol [25-hydroxyvitamin D] levels below 35 ng/ml.  Even when asked to 
check vitamin D levels, physicians often order calcitriol 
[1,25-dihydroxyvitamin D] levels, instead of calcidiol [25-hydroxyvitamin D] 
levels, an error which greatly misleads both the physician and the patient.

For numerous reasons (optimal calcium absorption, maximal suppression of PTH, 
reduction in blood pressure, decreased incidence of various cancers, retarding 
the progression of osteoarthritis, reducing sarcopenia (muscle wasting), 
reducing the incidence of autoimmune illness, reduction in CRP, etc), healthful 
blood levels of calcidiol [25-hydroxyvitamin D] are between 35 and 55ng/ml 
although commercial labs usually report “normal” or Gaussian distributions of 
between 8-72 ng/ml depending on the latitude of the lab’s population.  
Therefore, commercial reference laboratories also mislead physicians and their 
patients by reporting “normal” (Gaussian) distributions of a deficient 
population instead of healthful calcidiol [25-hydroxyvitamin D] levels.  
Patients need to know these facts before asking their physician for the 
calcidiol [25-hydroxyvitamin D] blood test.  Until the medical profession 
becomes knowledgeable on this matter, patients need to become educated, educate 
their physicians, get the proper blood test and then take steps to raise their 
calcidiol [25-hydroxyvitamin D] level if it is less than 35 ng/ml.  We know of 
no good reason to exceed 50ng/ml.  Documented toxicity may start at around 80 
ng/ml (200 nm/L), but that would require chronic sustained input from all 
sources of more than 20,000 IU per day.

Populations around the equator (where man evolved) and groups spending time 
outdoors without many clothes (lifeguards), have levels of around 50ng/ml. Such 
observations have important implications for the vitamin D conditions under 
which humans evolved. In other words, it suggests humans have had 
25-hydroxyvitamin D levels of around 50 ng/ml for 99.99 % of the time they have 
been on earth.  Only in the last several hundred years has urbanization, 
industrialization, glass (UVB does not penetrate glass), excessive clothes (UVB 
does not penetrate clothes), sunblock and medical advice to completely avoid 
sunlight lowered 25-hydroxyvitamin D levels to their currently deficient 
levels.  

Persons with low levels have three choices: the sun, a low-pressure sunlamp or 
vitamin D supplements.  One cannot obtain adequate vitamin D from food unless 
one regularly eats very large quantities of oily fish.  Milk is supposed to 
have 100 IU of vitamin D a glass but often contains less.  Contrary to popular 
belief, most other dairy products have none.

At most latitudes in the USA, little or no vitamin D is made in the skin in the 
late fall and early winter.  In northern states, the vitamin D blackout lasts 
for almost six months.  In the spring and summer, young Whites can make large 
amounts (20,000 IU) by sunbathing on both sides, without sunblock, for a few 
minutes (about 1/2 the time it takes for the skin to begin to slightly redden). 
 UVB meters can be most helpful in determining if there is sufficient UVB in 
the sunlight at your latitude, season and time of day, 
(http://www.solarmeter.com/model6.html).  Older person need longer exposure and 
do not have the robust abilities of the young but can still make 8,000 IU in a 
single full body exposure. Darker skinned persons need 5 to 10 times longer 
depending on the amount of melanin pigment in the skin.  Vitamin D production 
occurs within minutes and is maximized long before the skin turns red or begins 
to tan.  One does not have to worry about toxicity or get repeated blood tests 
when using sun exposure to obtain vitamin D.  Toxicity cannot occur even with 
heavy and continuous sunbathing because ultraviolet light begins to degrade 
vitamin D in the skin after making about 20,000 IU, thus reaching sated state.  
Overexposure, especially sunburns, is damaging to the skin, dangerous, and 
should be entirely avoided.

Some artificial low-pressure sun lamps contain significant amounts of UVB and 
raise calcidiol [25-hydroxyvitamin D] levels into the healthful range.  Just 
like the sun, one does not have to worry about toxicity or obtain repeated 
blood levels, when using them.  However, just like the sun, care must be taken 
not to overexpose the skin. Suntans are not needed to obtain adequate vitamin 
D.  Sunburns must be avoided.  One manufacturer with some vitamin D data is 
Sperti: http://www.sperti.com/products.htm. 

Many people are beginning to rely on supplements to raise their calcidiol 
[25-hydroxyvitamin D] levels as they have been told (usually erroneously) to 
entirely avoid any sunlight. (Totally avoiding the sun and supplementing with 
vitamin D assumes that the only benefit of sunlight is vitamin D, which is a 
premature and potentially dangerous assumption).  In the complete absence of 
UVB, one must consume 3,000 to 5,000 IU of cholecalciferol a day to maintain 
healthful calcidiol [25-hydroxyvitamin D] levels.  Similar studies have not 
been done with ergocalciferol but current data indicates that almost twice as 
much ergocalciferol would be needed.  Vitamin D repletion is safest when done 
under a physician’s care so calcidiol [25-hydroxyvitaminD] levels (and perhaps 
calcium levels) can be monitored.  Persons diagnosed with sarcoidosis, other 
granulomatous disease, cancer (especially lymphoma) or hyperparathyroidism 
should not take vitamin D unless they are under the care of a knowledgeable 
physician (and would be well advised to find one).  Patients with these 
conditions may develop a vitamin D hypersensitivity syndrome, which is 
different from vitamin D toxicity.

Persons who do not want to have blood tests would be best advised to rely on 
prudent sun exposure.  If such persons choose to avoid the sun, they should 
never exceed 2,000 IU of cholecalciferol a day [which is the Institute of 
Medicine’s NOAEL (No Observed Adverse Effects Level)].

Cholecalciferol can be obtained at health food stores and on the internet.  
Ergocalciferol can be obtained in 25,000 and 50,000 IU doses via prescription 
from your doctor.  We obtain pharmaceutical grade 1,000 IU capsules of 
cholecalciferol made by Roche from the Life Extension Foundation: 
(http://www.lef.org/newshop/items/item00251.html).  Cod liver oil contains 
about 1200 IU of vitamin D per tablespoon but also may contain about 14,000 IU 
of vitamin.  Therefore, persons with no sun exposure may exceed safe intakes of 
vitamin A in order to replete the vitamin D system.  (We know omega-3 nutrition 
is very important but believe fish oil to be a safer alternative than cod liver 
oil).

Vitamin D can be toxic in overdose (more than 40,000 IU a day over several 
months).  Virtually all the toxicity reports in the literature are iatrogenic: 
large doses of ergocalciferol prescribed for medical reasons (usually 
hypoparathyroidism or osteoporosis). We are not aware of any reports in the 
literature of deaths from acute overdose, such as murder or suicide. In fact, a 
150-pound human would have to take more than 100,000 capsules of the 1,000 IU 
cholecalciferol capsules to approach the LD50 for the most sensitive mammal 
(the male rat at 40 mg/kg). Such patients would be more likely to die from 
gastric bloating leading to asphyxiation than from vitamin D toxicity.  In 
mammals, signs of toxicity short of death can first be seen at.5mg/kg (20,000 
IU/kg or 1,400 capsules at one time for a 150-pound adult human).  We are 
unaware of any reports of vitamin D toxicity from cholecalciferol supplements 
except when manufacturing errors occurred.  Most of the reported toxicity is 
industrial (dairies putting in the wrong amount into milk or the concentrated 
oil being used for cooking). However, death from chronic poisoning has been 
described and is possible.  If you believe “a little is good then a whole lot 
is better,” then you may prove an association between judgment and Natural 
Selection.


LEGAL ASPECTS:

To date, we know of no physician who has had a malpractice action filed against 
him for failure to diagnose or treat vitamin D deficiency.  We are not aware of 
a single dermatologist held liable for telling a patient to totally avoid the 
sun (without taking care to monitor their calcidiol [25(OH)D] levels), no 
matter how many vitamin D deficiency associated diseases that patient 
subsequently develops.  However, commercial reference labs that mislead 
physicians with outdated “normal” distribution levels (Gaussian distributions 
of deficient populations), instead of healthful or ideal calcidiol [(25(OH)D] 
levels, do have obvious liability exposure as do dermatologists who assume 
control of the vitamin D system via their sun-abstinence advice. The Vitamin D 
Council has attempted to educate, via registered letter, the American Board of 
Pathology as well as the five largest commercial reference labs in the USA 
about the danger of misleading 25(OH)D reporting methods and the damage those 
misleading reports may engender.  We plan additional such educational 
activities directed at the American Academy of Dermatology.  

Things change quickly in tort law; as soon as readers know of any vitamin D 
cases, we would like to hear about them. Current medical journals are full of 
dire warnings by the top experts.  As unfair as such suits would seem to 
practicing physicians, we believe continued suffering from undiagnosed and 
untreated vitamin D deficiency is more unfair.  The Vitamin D Council feels 
malpractice suits are inevitable and, no matter how disquieting, will herald 
the end to death and disability due to undiagnosed and untreated vitamin D 
deficiency.  

Remember, losing a malpractice case requires that only a preponderance of 
evidence (51%) was against you, not proof beyond a reasonable doubt.  
Scientific proof is not required, only opinions by medical experts that meet 
the legal (Daubert) standards for experts.  Some physicians also mistakenly 
think standard care is the same as Standard of Care; they are not and never 
have been.  Standard care is what most doctors do, Standard of Care is what one 
jury thought one physician should have done with one patient at particular time 
in one particular jurisdiction.  Most importantly, Standards of Care are never 
determined by the Institute of Medicine, the Food and Nutrition Board, the 
National Institute of Health, the American Medical Association, practice 
guidelines, your supervisor, your Chief of Staff, your colleagues or this 
publication.   Standards of Care are only determined by triers of fact (judges 
or juries) after listening to testimony of experts whose credentials are vetted 
by the court. 


ABOUT THE VITAMIN D COUNCIL:

The Vitamin D Council is a group of citizens concerned about vitamin D 
deficiency and the diseases associated with that deficiency.  We have recently 
changed our name from The Cholecalciferol Council to the Vitamin D Council.  
The Vitamin D Council will attempt to draw attention to the problem of vitamin 
D deficiency through the education of professionals, the media, government 
officials and average citizens.  Our immediate goal is to fund our non-profit 
corporation. The Vitamin D Council’s long-range goal is to end the needless 
suffering and death from vitamin D deficiency. Our initial campaign will center 
on enabling the Institute of Medicine’s Food and Nutrition Board to reconvene 
an expert panel on vitamin D nutrition so they can update their recommendations 
on vitamin D to make it current with today’s science.  We also hope to secure a 
grant to allow us to publish an academic journal on Vitamin D, contracting with 
one the scientists below to serve as executive editor and others to serve as 
associate editors.  We would then offer subscriptions to the academic 
community, including readers of this newsletter.  However, the Vitamin 
newsletter you are currently reading will remain separate from the proposed 
academic journal and will remain free for the foreseeable future.

The Vitamin D Council is a nonprofit entity incorporated under the laws of 
California under the name Cholecalciferol Council.  We are a now a tax-exempt, 
non-profit[501(c)(3)] educational organization under the laws the United 
States.  We currently have no funding but will soon apply for grants as our 
[501(c)(3)] status was recently granted.  We will not accept donations or 
grants from individuals or organizations whose goals may conflict with ours.  
Particularly, we will not accept any donations from the American Trial Lawyers 
Association or groups that represent them.  The president of the Vitamin D 
Council is John Jacob Cannell, MD, the vice-president is Tatiana Cannell, MD, 
the secretary is Olga Cebanova, MD, MD, and the treasurer is Andrei Gutsu, MD.



--
To unsubscribe from: The Vitamin D Council, just follow this link:

http://cholecalciferol-council.com/cgi-bin/dada/mail.cgi?f=u&l=cclist&address@hidden&p=5166661

Click this link, or copy and paste the address into your browser.