firstname.lastname@example.org Cape Town.
This column regularly reviews and refers to the contentious issue of Regulators and Big Pharma suppression and disparagement of natural micronutrient supplements – The Vitamin Wars in which Jack Drummond and Linus Pauling were so embroiled by persecution and assassination- so as to promote sales of designer drugs and focus on treatment not primary prevention, on the obviously sound shortterm economic principle that prevention does not pay, Only Disease Pays.
Recent key papers perhaps expose the falseness of the vitamin conspiracy, the condemnation if not regulatory suppression of free choice supplements in favour of risky designer drugs like antimicrobials on the FDA’s (ie the New Drug Industry’s) efforts to protect the Disease Industry with the self-serving but poor argument that experience and observational and evolutionary evidence are not good enough, only randomized controlled trial evidence will do.
This despite the major studies that vitamin D in optimal dose, like vitamin C, in fact in optimal multinutrient combination, offers better protection – prevention and treatment- than any designer drugs against all diseases, from acute and chronic infections eg flu, HIV and other STDs, and tuberculosis and other bacterial (and parasitemia) infections, to autoimmune, lipid- hypertensive-vascular disease, depression and cancer, prevention of frailty and fractures, even sexual-reproductive health, dementia and multiple sclerosis – as Dr John Cannell of the Vitamin D Council repeatedly details.
Earlier this year a research centre in San Francisco estimates benefit of increased vitamin D status in reducing the economic burden of disease in western Europe. The reduction in direct plus indirect economic burden of disease was based on increasing the mean serum 25(OH)D level to 100nmol/L, which could be achieved by a daily intake of 2000-3000 IU of vitamin D. For 2007, the reduction is estimated at euro187,000 million/year. The estimated cost of 2000-3000 IU of vitamin D3/day along with ancillary costs such as education and testing might be about euro10,000 million/year. Sources of vitamin D could include a combination of food fortification, supplements, and natural and artificial UVB irradiation, if properly acquired. Steps to increase serum 25(OH)D levels can be implemented now based on what is already known.
A University Toronto study last month on How to optimize vitamin D supplementation to prevent cancer, based on cellular adaptation and hydroxylase enzymology by Prof Robert Vieth Univ Toronto, Canada analyzes the question of “what makes an ‘optimal’ vitamin D intake” ie ‘what serum 25-hydroxyvitamin D [25(OH)D] do we need to stay above to minimize risk of disease?’. This simplistic question ignores the evidence that fluctuating concentrations of 25(OH)D may in themselves be a problem, even if concentrations do exceed a minimum desirable level. It explains why higher 25(OH)D concentrations are not good if they fluctuate, and that desirable 25(OH)D concentrations are ones that are both high and stable.”
A new study last week from Finland probes the benefits of vitamin D in institutionalized adults with intellectual disability ID, who may eat poorly and seldom get any sunshine. . Those given 800iu vitamin D daily for 6 months did better than those given simply 150 000iu imi at the start, when all had a mean vit D bloodlevel of 40nmol/L, the oral dose group having a final level of 82 compared to 62 nmol/L in the other group. PTH fell in both groups, but target D3 level of 80 was attained in 42 % orally vs 12% imi.
and now this week Pietras ea from Boston detail how Vitamin D2 Treatment 50 000iu fortnightly for up to 6 years for Vitamin D Deficiency and Insufficiency in Boston increased vitamin D levels from 67 to 117 nmol/L, without change in blood calcium, and no kidney stones- but with persistent vitamin D deficiency in perhaps 10%, for a variety of possible reasons. They agree that oral vitamin D3 is the best preparation. This is retailed in South Africa for as little as R6 (($0.80) per 50 000iu. In fact, unless the patient has shortterm absolute contraindication to oral-enteral supplement, there is no better (ie parenteral) route for vitamin D3 if not all supplements than via the stomach.
The short answer is that, from local and international experience with such doses, there is indeed no evidence of harm, only benefit- ie nothing to lose. Prudence dictates query about history of hypercalcemia/ kidney stone problems, and baseline and followup check of at least serum calcium phosphate and creatinine if not also vitamin D levels, to judge whether dose of 2000iu or 10 000iu/day (or 50 000iu every week or month) is both enough to produce stable blood level in the range of 125 to 150nmol/L, and safe for the individual.