Supplement: Vitamin D – are you getting too much?

vitamin-d-food-sources

Updated 4 December 2013 – if you are using GcMAF, the manufacturers recommend taking 10,000 IU of Vitamin D daily.  They also use higher levels of serum Vitamin D, much higher than the ones recommended in this post.  In Germany, some practitioners are using up to 300,000 IU per day.  This contradicts a lot of the advice on safe levels.

I started getting interested in Vitamin D because I had two Vitamin D level tests fairly close together which showed disparate results.

The first was done in the UK in December 2012.  It showed that my levels were normal.  Then a few months later, I had my levels measured at Hallwang, and it showed that my levels were deficient.  I was surprised as I had been taking Vitamin D supplements.

So it prompted the following questions:

- were the reference ranges for Vitamin D levels flawed?

- or were my levels of Vitamin D really deficient?

- or were the supplements I was taking not effective?

- or was I not getting enough Vitamin D because of the lack of sunshine in the winter?

- what was the optimum level of Vitamin D?  Was more better? – I asked an eminent oncologist this recently, and his answer did not match up to the studies I’ve been reading.  So could it be that even members of the medical profession are not aware of what is a good level of Vitamin D?

- what was an effective Vitamin D supplement?

Vitamin D is the new Vitamin C, the Miracle Supplement that’s supposed to inhibit and prevent cancer, strengthen bones and muscles, lower blood pressure, boost the immune system and generally save the world.

So it’s natural to assume that if Vitamin D is a good thing, then the more you take, the better, right?

Unfortunately … not.

While low levels of Vitamin D have been associated with a higher incidence of death from cancer, the evidence for higher levels is inconclusive.

In fact, there is a strong possibility that too high a dose of Vitamin D could lead to a higher risk of death from other causes.

Imagine the irony of dying from a heart attack instead of cancer, because of an OD of Vitamin D!

So how can you make sure you’re getting too little or too much Vitamin D?

What is Vitamin D?

“Vitamin D is a group of fat-soluble secosteroids responsible for enhancing intestinal absorption of calcium and phosphate. In humans, the most important compounds in this group are vitamin D3 (also known as cholecalciferol) and vitamin D2 (ergocalciferol)” (source – Wikepedia)

Which Vitamin D?

There are a number of forms of Vitamin D.  The most natural and active form is Vitamin D3, or also known as 25-hydroxyvitamin D3 (Cholecalciferol).  It is this Vitamin D3 that you should get tested for.  Vitamin D can also be absorbed from food and also manufactured by the body, through the exposure of sunlight on skin.

Why test for Vitamin D?

We need to test for Vitamin D because we don’t know what levels of Vitamin D we have.  Read this article in the Daily Mail on five volunteers (without cancer) who had their Vitamin D levels tested which shows how even seemingly healthy people can have low levels of Vitamin D.

And, by extension, you could be happily supplementing with Vitamin D, and have too high levels.

You need to test regularly – I would say at least once a year to every six months.  However, testing by different labs may reveal different results.  This was something I discovered this year – I was tested in December in the UK, and my Vitamin D levels were normal.  However, when I got tested in Germany, I was shown to be slightly-deficient.

But I have a tan, doesn’t that mean I have enough Vitamin D?

Surely exposure to sunlight is sufficient for Vitamin D systhesis?  An article in Weston A. Price shows this is not always the case:

The ultraviolet wavelength in sunlight that stimulates our bodies to produce Vitamin D is UV-B.

“UV-B is present only during midday hours at higher latitudes, and only with significant intensity in temperate or tropical latitudes. Only 5 percent of the UV-B light range goes through glass and it does not penetrate clouds, smog or fog.”

Furthermore, the amount of UV-B present has to do with the angle of the sun’s rays.

“Latitudes higher than 30° (both north and south) have insufficient UV-B sunlight two to six months of the year, even at midday.  Latitudes higher than 40° have insufficient sunlight to achieve optimum levels of D during six to eight months of the year.  In much of the US, which is between 30° and 45° latitude, six months or more during each year have insufficient UV-B sunlight to produce optimal D levels. In far northern or southern locations, latitudes 45° and higher, even summer sun is too weak to provide optimum levels of vitamin D.”

London is located at a latitute of 51 degrees North, Sydney at latitude 33 degrees South, New York at 41 degrees North – all latitudes higher than 30 degrees (North or South) (Check out this website to find out the latitude for your country and city).

Let’s say you do expose yourself to the sun, here are the guidelines for how much exposure you need:

“The current suggested exposure of hands, face and arms for 10-20 minutes, three times a week, provides only 200-400 IU of vitamin D each time or an average of 100-200 IU per day during the summer months.

In order to achieve optimal levels of vitamin D, 85 percent of body surface needs exposure to prime midday sun.

Because the body needs 30-60 minutes to absorb these vitamin-D-containing oils, it is best to delay showering or bathing for one hour after exposure. The skin oils in which vitamin D is produced can also be removed by chlorine in swimming pools.”

So to cut a long story short, chances are if you live in London or New York, you will not be getting optimal levels of UV-B to make Vitamin D.  And even if you live in the tropics, well, I have friends who live in Singapore and they avoid the intense sun like the plague, which makes me wonder what their levels of Vitamin D are.  Getting tanned once a year on an annual holiday, or swimming in an outdoor chlorinated pool will not give you adequate levels for the rest of the year. You need consistent levels of Vitamin D for it to be therapeutic.

Which Vitamin D test?

There are two vitamin D tests — 1,25(OH)D and 25(OH)D.

The test you need is 25(OH)D, also called 25-hydroxyvitamin D.  This is the better marker of overall Vitamin D status, and is most strongly associated with overall health.

Vitamin D can be measured in ng/ml (nanogrammes per millilitre) or nmol/l (nanomols per litre).  Multiply ng/ml by 2.5 to get nmol/l.

Can’t I get Vitamin D from food?

Sure you can, if you eat naturally-reared free-range happy poultry, the skin and organs of fatty fish, the yolk of eggs and the skin and organs of animals, birds and reptiles that have been exposed to UV-B.  Unfortunately, modern day diets lack these foods.  Vegetarian and vegan diets are poor in Vitamin D.  So unless you live in the tropics, and get plenty of sun exposure, and eat free-range food, you should supplement if your levels of Vitamin D are low.

Where should your Vitamin D levels be?

For primary prevention, Dr Trutt recommends nothing higher than 50ng/ml (that’s 125 nmol/l).  Nothing lower than 40ng/ml (that’s 100 nmol/l).  My current levels oare 122nmol/l.  I was ecstatic, until I attended a conference on GcMAF to discover that they were advocating levels over 200nmol/l, and the GcMAF researchers claim they have not seen any toxic side-effects on 10,000 IU of Vitamin D per day.

(There is a study that shows that at levels higher than 50ng/ml, the chances of All-Cause Mortality are 50% higher.)

Life Extension Foundation says that the optimal range is between 50ng/ml to 80ng/ml.  Dr Trutt shows that this is not correct and is based on flawed assumptions.  See the transcript of his talk disproving LEF’s recommendations, below.

Which Vitamin D supplement?

As with all other supplements, Vitamin D comes in many shapes and sizes.  I’ll show you what’s available, and what worked best for me.

Supplementation is safe as long as sarcoidosis is not present.  (Sarcoidosis is a rare disease that causes body cells to form into clumps, called granulomas, in the organs of the body (often the lungs and skin).  Also, liver or kidney disease should not be present and the diet should contain adequate calcium, magnesium and other minerals.

Types of vitamin D supplement:

I’m going to keep this brief.  There are pills, there are sprays, there are drops.  The issue again is bio-availability.

Vitamin D needs fat to be soluble.  So pills should be taken with a meal that contains fats/oils.  Better to get Vitamin D in capsules that contain oil.  Mercola.com recommends a spray.

MicellizedD312001oz

The brand that I take is NuMedica Micellized D3.  I took this brand because it was the one that was used in RGCC’s chemosensitivity test, and so I wanted the brand that worked for me.

And boy, did it work.  After I’d been taking it for about a month, I got my Vitamin D levels tested, and they were sky-high.  Too high, in fact.  This has been the only brand of Vitamin D that has given me such near-instantaneous results.

NuMedica claim it is a water-soluble Vitamin D:  “The micellization process produces tiny droplets (micelles) that are then formed into highly absorbable aggregate structures.  Micellization greatly increases the solubility, absorption and bioavailability of our vitamin D3 over oil or emulsified forms.”  I don’t know if their claims are true, all I know is that it works.  Each drop contains 1000-1,200IU of Vitamin D.  It is preserved in grapeseed extract, which some people claim interferes with the action of some medication, but I believe the amounts are too small to be significant and disagree.

Unfortunately, NuMedica Micellized Vitamin D is not available in the UK.  The only way to get it is to buy from the US.  Please note that all imports from the US will be charged customs duty if their value exceeds £17.  This is a scandal for patients where getting the best, and most cost-effective supplements are concerned.

Conclusion:  I got my Vitamin D tested again recently, and if Dr Trutt’s recommendations are correct, they are still too high.  And yet, my Vitamin D level is within the reference range for the laboratory.  So who’s right?  I’ll be updating this post when I get more information.

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LONG:  Transcript of Dr Josh Trutt’s talk on Vitamin D (from minute 41 onwards):

Please note, this is a verbatim transcript, and you should read it in conjunction with the presentation slides otherwise it won’t make as much sense.  You need the graphs of the studies to know what Dr Trutt is referring to.

1.  Study:   Melamed, NHANES III (2008) – 3rd National Health and Nutrition Examination Study

This was a study of All-Cause mortality.  Followed 13,000 people over age 20.  NH3 was designed as a probability sample of the total civilian population in the US.  Collected health and nutrition data of men, women and children from 1988 to 1994 and followed them for 6 years.  On the left is ACM.  On very low Vit D levels, ACM was higher than 1, and improved climbed again when Vitamin D levels was higher.  For women this was statistically significant.  Women above >50ng/ml had a higher ACM, then women with <50ng/ml

2.  NHANES III (2009) - Prospective Study of Serum 25-Hydroxy vitamin D Level.  Cardiovascular Disease Mortality, and ACM in Older US Adults – 34,000 people aged over 65.

Demonstrated a significant inverse association between baseline serum 25(OH)D level and mortality risk in older adults.  The association was strong (two time great odds of mortality for Vit D level <25nmol/l and appeared linear within the range of the data.

Is that true?  The hazard ratio is sort of linear, but the confidence levels are all over the place, and to me it looks as if a few parts are better, and there is overlap of confidence intervals.  Looking at the data, they’ve bolded the ones that were statistically significant, <25nmol/L and 25-49.9 nmol/L (=10-20ng/ml).  So if your levels are lower than 20 you did worse, and other than that it was a wash.  They only studied up to 40ng (which is what 100nmol/L) is.  So they didn’t even stratify above a level of 40.

3. NHANES 2012: looked at 29,000 adults

Mortality rates across 25-hydroxyvitamin D levels among adults with and without estimated glomerular filtration rate.  With or without renal function.  Levels below 20 are bad, and above that are all kind of awash.  40+ i.e. 43.5 was the median.

4.  2012 meta-analysis of Vitamin D vs ACM

14 prospective cohort studies were done in 2012. 62,548 individuals, 5562 deaths

Only the levels below 20 were statistically significant.  The confidence levels that don’t cross 1.0 are <25 nmol.  Levels below 20 are bad.

Conclusion:  they saw a prime area (the level they thought was the best) was 75-87 nmol (32 nmg).

5.  2012 COPD Study (JCEM journal) - A reverse J-shaped association of ACM with serum 25-Hydroxyvitamin D in General Practice, the CopD study

Retrospective observational cohort study and they looked at Vit D Levels of 250,000 people in Copenhagen, Denmark.  Aged 45-55.  Followed them for 3 years. Wow – the lowest mortality risk was at a level of 24 ng (60nmol) – lower than I expected.  At very low levels, the hazard ratios for ACM was 2.13 and that was stastistically significant and at higher levels, the hazard ratio went up again.  At a level of 56ng (which is something like 140 nmol) the hazard ratio was 1.4 and the confidence interval was 1.3 to 1.5.  This excluded people from within 1 year of blood collection so they tried to exclude the people who were really sick at the time they drew the blood.  Are their assays different as their levels are so low.

Last but not least – the last ACM study.

6.  Study – Vitamin D Levels for preventing acute coronary syndrome and mortality:  evidence of a nonlinear association.

Israel has universal healthcare and there are three HMOs that the population uses.  The HMO that did this survey covers 50% of the pop and the EMR has data for the past 13 years.  Their EMR is an excellent resource for robust datamining.

They looked at Vitamin D in 432,000 people over 45 years old and they gathered data for 4.5 years and they tracked them for death from any cause as well as for ACS events.  Worse outcomes came in patients with levels of less than 10 which is what we would expect and then followed by 10-20 and the sweet spot was for levels of 20-36 ng/ml and above 36 the hazard ratio again increased to 1.13 and the p value was less than 0.05.  So again, above 36 was worse.

What about cancer?

I can find no evidence for ACM improving above levels of 40ng/ml and appears to get worse.  ACM should be the yardstick we use because what use is preventing breast cancer if they die of heart attack?

So where is the meme of a level of 60 ng/ml coming from?

7.  2005 Breast Cancer Study - Cancer Epidemiology, Biomarkers and Prevention - Plasma 25-Hydroxyvitamin D and 1,25-Dihydroxyvitamin D and Risk of Breast Cancer

Followed 33,000 women from 43-69 from a nurse’s health study.  1990 blood sample.  Followed them for 6 years and separated them into quintiles based on vitamin D level.  Lowest quintile was anything under 28, highest was above 48.  The highest three quintiles had exactly the same risk.  They did look at women who had higher rates in this study.  The highest group had levels above 48ng.  They found there was no difference in the highest 3 quintiles in breast cancer risk.  Only the levels of less than 34 had any difference.  There is a possibility that a threshold exists of Vitamin D above which women experience protection from breast cancer, but that having plasma levels higher than that does not reduce risk.  And that cut-off turned out to be 34 ng.

8.  NHANES III – Journal of the National Cancer Institute - Prospective study of serum Vitamin D and cancer mortality in the United States

Followed 17,000 people from 2007.  They measured Vitamin D levels between 1988-1994.  Followed them for 6 years.  They found no association between Vitamin D and total cancer mortality, but they found that colo-rectal cancer mortality was inversely related to Vitamin D levels.

Levels of 32ng or higher had a significant risk reduction – 72% risk reduction compared to people less than 20ng.  So for breast cancer you want levels higher than 34ng, for colon cancer, you want higher than 32.  Nothing about levels above 50 or above 40.  In this trial, they had patients with levels above 100 nmol 32ng).

9.  Study:  Breast Cancer (2009) - Association between plasma 25-hydroxyvitamin D and breast cancer risk

21,000 women.  Measured Vit D levels at the time of diagnosis rather than measuring it years prior to the diagnosis.  They found that women with levels above 40ng had a significant reduction.  My question though, if you look at they made the cut, what would have happened if they had been looking at 35-45ng because other studies have found cut-off points at 32-34.  I wonder 35-45ng should have been the cut-off as opposed to it needing to be 40.

So where is all the talk coming of levels of 50, 60, 70?

Life Extension Magazine:  “In 2006, the Journal of the National Cancer Institute published results from a huge population study showing lower cancer deaths in response to higher vitamin D blood levels.

Compare to Vitamin D levels of 20 ng/ml, this study indicated that those with a level of 50 would have a 51% reduction in total incidences of cancer.”

Wow!

Here’s the study:

10.  JNCI - Prospective study of predictors of Vitamin D status and cancer incidence and mortality in Men

  • Unusual.  They calculated what they thought people’s Vitamin D levels would be based on a predictive model of skin pigmentation, sun exposure, where they lived, body mass, exercise (they assumed that if you exercise more you were exposed more to the sun), season of the year, and how much Vit D they were supplementing with.  The formula showed that if you increase by 10ng, then there was a decrease in the cancers colon, pancreas, esophagus, oralpharangeal.  Brain cancer trended an increase with increase in Vitamin D as well as melanoma.

The catch:  “Our model identified a wide range of predicted Vitamin D levels, from a summer high of 36/ml for a man with all favourable characteristics (i.e. Highest intake, residence in the southern US, lowest BMI, highest activity level, and low skin pigmentation) to a winter low of 9ng/ml for a man with the opposite extreme characteristics.

Their study did not go above 36ng/ml – that’s important to realise that their highest prediction was 36ng and the worse was 9ng.  So they looked at levels between 9 and 36 and found a big difference, which we already know.

They said:  “an increment of 10ng/ml was associated with a 17% reduction in total cancer incidence.” [but only within the range of 9-36ng/ml!!!]

They said:  “A further risk reduction is possible for even higher Vitamin D increments – but larger increments were beyond the range of our data.”

But LEF SAID THIS:  “Compare to levels of 20 (ng/ml), this study indicated that those with a level of 50 would have a 51% reduction in total incidences of cancer.”

So basically LEF multiplied it by three, i.e. 10ng lowers cancer by 17%, so 30ng will lower it 51%.

Then LEF said, “The JNCI study authors concluded that to increase 25-hydroxyvitamin D from a low of 20 to a higher 50ng/ml – about 4,500 IU a day of vitamin D supplementation would be necessary.

… But that is not true.  The conclusion the authors of the study drew is:  “Achieving a 25(OH)D increment of 10ng/ml may require supplementation of at least 1,500 IU/day, a safe but not generally encouraged level.

11.  Study – Vitamin D and prevention of breast cancer – pooled analysis.  (Journal of Biochemistry and Molecular Biology) - the only study that flat out advocated for levels above 50

  • They looked for studies that measured vitamin D in quintiles vs breast cancer risk and that also provided odds ratios.  Only found 2 studies they could use.  Their      conclusion was that if you bring your levels above 52ng, you will have a 50% reduction in breast cancer.  The two studies they used – we’ve seen the first (no diff in top 3 quintiles).  The other study they used a baseline of 60 and compared risk as the levels dropped to 50 or 40 or 20.  The difference in the first two, was not statistically significant (<50) and (50-100).  But when you got below 20 there was a big statistical difference.  They combined two studies that were not statistically significant.  Did they go to the authors and get the actual lab values or combined the quintiles?  This was the only study I could find that pushed overtly for levels of 50 to prevent breast cancer.
  • The authors did the same for colon cancer – pooled analysis from other studies and concluded you need a level of 32.  So the conclusion of 50ng was only for one disease – for breast cancer.

My next question would be:  so if I accept that a level of 50 would lower the risk of breast cancer, from an odds ratio of 0.7 down to 0.5.  What about Mohamed’s study – at a level of 50, the relative risk of death from any cause was 50% higher?  And the study which showed a hazard ratio of 1.4 at 56ng.  And this study which showed a hazard ratio of 1.13 above 36ng.

So it’s not accurate to say the level should be above 40.  I haven’t seen anything for levels above that for primary prevention.”

End of section of talk on Vitamin D Dr Trutt.

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