Category Archives: vitamins

VITAMINs K2+D3 – VITAMIN DUO OF THE NEXT DECADE

update 16 May 2016.   to our health: neil.burman@gmail.com

HIGH TO MASSIVE DOSE VITAMIN D3 IMPORTANCE – TEN TIMES MORE THAN MAXIMUM SUNLIGHT CAN PROVIDE – IN REVERSING  COMMON VIT D DEFICIENCY/RESISTANCE FOUND IN ALL MAJOR DISEASE eg ALL  INFECTIONS, INSOMNIA, MULTIPLE SCLEROSIS MS,  Myasthenia Gravis, SLE, RA, PARKINSON’S, DEPRESSION, VASCULAR DISEASE, CANCER, VITILLIGO, PSORIASIS,  PERIPHERAL NEUROPATHIES, MENTAL ILLNESS.

  introduction:     Cape Town is the world epicenter of epidemics (of poverty – malnutrition- HIV- HAART- TB –Diabetes, asthma-COPD,  and vitamin D  and iodine deficiency). And we  are seeing neuroarthropathy with a vengeance in our township clinics, where a majority of such diabesity or/and HIV patients  admit if questioned to chronic burning cramping legs  and sore muscles/joints if not also consequent insomnia, falls and leg ulcers.

Poor ill patients  seem to  accept it- neuroarthropathy-  as a way of life since it  usually has no visible signs (for anyone to see) till late– poor circulation, ulcers, falls,  arthritis- , and  malnourished diabesity patients  have bigger worries with uncontrolled diabetes and often uncontrolled hypertension despite even insulin; and the HIV+-Tuberculosis patients  have the multiple toxic burdens of antiretroviral and antituberculous therapy.

Because the burden of these diseases as well as stress from corruption and violence  here  is amongst the highest in a major city in the world, affecting especially the poorest and most illiterate labourers, state clinics rarely have budgets to cover the necessary vitamin and mineral supplements the poor  also need on their poverty fast food diet.

Our patients  accept that in return for life extension by designer antimicrobials and antidiabetic/ antihypertensives, all they will get for pain relief  is the combination of physiotherapy, and  designer synthetic palliative drugs- paracetamol, ibrufen /diclofenac, tramadol, amitryptiline, and if lucky some ung meth sal . These factory-synthesised drugs  give little relief,  and no improvement in prognosis since they do not address the proximate causes of the neuroarthropathy,  associated depression and  work incapacity (and later strokes, arthritis, dementia, ulcers, gangrene, chronic lung/heart/ liver/ kidney/visual disease)- respective causes including stress,  infective, drug-induced, tissue glycogenation, the misguided fast-food high carbohydrate-low fat diet  obesity; and manual labour/multiple trauma  wear and tear, and nutritional deficiency including much-needed marine and saturated fats, vitamins and minerals..

The pioneer  work discussed below in Pakistan(Salahuddin ea, Basit ea), Italy (Cipriani ea) and Brazil (Coimbra ea) in using respectively Vit D3 ~700 000iu loading dose and chronically up to 1000iu /kg/day ie average 70 000iu/day, up to 120000iu per day to reverse deadly acute and chronic disease,  is comparable in its simplicity safety and low cost to :

*Semmelweis’ revolutionary discovery  Vienna in the mid 19thC  of hand disinfection to decimate childbirth sepsis deaths; and

*Pauling’s landmark lifesaving escalation of Vit C dose to a gm  per kg per day for all severe disease; and

*the parallel discovery in UK and USA of the crucial role of not just the RDA preventative microdose but also the pharmacological anti-disease benefits of 10 to 100times bigger doses of all the vitamins B complex 1 to 12.

Cipriani ea 2010 seems to be the first report on Pubmed of deliberate oral dosing with  megadose     600 000iu vit D3 ie 10 000iu/kg, albeit only in health to assess bloodlevel response and safety. Since then, as we previously noted, 2 million unit single overdose in nonagenarians in Netherlands  has been shown to do no harm – ie about 40 000iu/kg. .

And as the Australians and others report below, there is no hint of vigorous vitamin or mineral  supplements being stigmatized as performance enhancing for eg sport –  despite vitamin D3 having the distinction of being truly an anabolic ie performance-enhancing (seco)steroid .

There is no point in giving vitamin D by injection (except in those in ICU on prolonged nil per mouth) since it is so well absorbed provided given with fat eg in fishoil/coconut/DMSO oil. And obviously the higher the dose given, the more important to avoid more than a traditional multisupplement pill a day  with low calcium and vitamin A retinol; combined with a low calcium diet (ie low dairy low peanut) ; and supplementing plenty fresh green produce [providing magnesia a few hundred mgs a day, and vitamin K2 perhaps 35mcg/d].

Dr  Mike Holick Prof of Medicine at Boston University interviewed by Dr Joe Mercola Dec 2015 details  the  rationale underpinning the (eg Coimbra) massive vit D3 dose regime for severe immune disease, “as opposed to  plenty of sensible sun exposure for general good health and lower deathrate from all diseases and infections.                 Most melanoma occurs on the least sunexposed skin, with lower melanoma and all other deaths with high sun exposure. Dark days promote melatonin and thus daytime sleepiness and depression- which bright light in the morning for an hour reverses, and elevates b-endorphan, which has many times the painkilling effect of morphines ie opioids, and antidepressants. Vitamin D deficiency more than doubles the risk of all diseases; even 2000iu vit D3 a day in the 1st yr of life in Finland halved the risk of type 1 diabetes– with loss of protection if vit D dose dropped to 400iu/day. Vitamin D/ sunlight reverse leukemic cells. But maximum sunlight exposure nearer the tropics still only elevates 25OHvit D level to a maximum of about 50ng/ml- whereas increasing evidence proves that it may take more than 10 times that bloodlevel to prevent and treat deadly diseases- depending on your genetic vitamin D receptors.

 Even 1000iu/d vit D with bld level about 30ng/ml halves risk of many cancers, with doubling benefit as 25OHvit D level is doubled serially  eg by 10 000iu/d or 50 000iu/d. The kidneys however limit production of the hypercalcemic 1,25vit D, thus avoiding hypercalcemia provided calcium intake is not supplemented by calcium pills, nuts. vit A  etc. The higher the vit D level above 30ng/ml (up to >? 500ng/ml), the more  of our 2000 enzyme systems are activated  to fight all disease without hypercalcemic risks. Hunter gatherers had levels twice as high as dressed housed people today, around 50ng/ml, with increasing anticancer and antiinfection/antiautoimmune benefit from vit D up to safe levels eg 100ng/ml and higher. .”

At Thisisms.com this is multiple sclerosis  March 2016 seems to be the latest from neurologist  Dr Cicero Coimbra  via grassroots health. He stresses that to cure degenerative/ autoimmune disease eg  MS, Parkinson’s, SLE, RA, vitiligo ie to overcome genetic Vit D resistance may require vit  D titration up to 1000iu/kg/d ie up to even 40000iu/d to 200000iu/d,
And 25OHvitD blood level to 1000ng  and even 4000ng / ml for a few years to produce cure, before reducing to maintenance vit D3  eg 100iu/kg/day ie ~ 50000iu/wk.
Hypercalcemia and thus calcinosis  is avoided provided PTH level is maintained in the low normal range, not suppressed. Optimal support includes low calcium and  high water diet and  Vit B2, magnes selenium zinc phosphor  supps.

      COST IMPLICATION:

The spectrum of vitamin D3 adult dose thus extends from the

traditional prevention RDA 10iu/kg/ ie~700iu/d against rickets (infants start with 1000iu/d or 25000iu ie ½ scoop/month of standardized vit D3  100iu/mg powder)

to  vigorous 100iu/kg/day (ie 50 000iu scoop /wk ) for common disease prevention/treatment (toddlers 2000iu/d/ ½ scoop/fortnight));

 to  massive  1000iu/kg/day eg 60 000iu/dy for severe autoimmune/immunodeficiency diseases – with mandatory monitoring of levels of calcium, creatinine, 25OHvitD3 and now PTH levels;

to mega 10 000iu/kg eg 650 000iu as a loading dose for eg TB or meningitis or severe trauma—which dose may maintain  25OHvit D3 blood levels in a “sufficiency” range above ~40ng/ml for a month or two, so obviously requires appropriate maintenance dosing.

Imported vitamin D3 100cwt concentrate powder (100iu/mg) per kg from an importing pharmacist costs about R500/kg ie R0.50/100 000iu- far lower than the cost of the highrisk plant xenocalciferol vitamin D2. Thus to the State (excluding packaging and dispensing cost) , the wholesale cost of vit D3 is about R0.15 per 50 000iu per week for maintenance dose; or for 50 000iu/day R10( US $0.6)/month ie retail abt R60pm ie US$5  for megadose therapy; compared to the quoted retail US$20/month in Brazil. .

     THE NEUROPATHY OF DIABETES, DRUGS/TOXINS, POST-VIRAL,TRAUMA,  SPONDYLOSIS, DEMENTIA:

PERIPHERAL NEUROPATHY:  Already in 2006 Oh-Park ,Sheehan .ea,  Lancet. Albert Einstein College of Medicine, New York wrote about AIDS-ARV neuropathy Charcot neuroarthropathy in the era of HAART.

Young, Dancho ea Tucson, Arizona, wrote 2012,   ” Charcot arthropathy is a devastating joint condition that affects persons with neuropathy. With HIV/AIDS treatments prolonging the lives of these persons, it is likely that long-term sequelae of the disease will become more evident in the near future. Patients with this disease frequently develop peripheral neuropathy. A high index of suspicion must be raised in any patient with peripheral neuropathy of any cause and a red, hot, swollen, painful foot for Charcot neuroarthropathy to give these patients proper treatment to help prevent the devastating effects of Charcot neuropathy with its potential consequences including foot ulceration and amputation. We know only too well the same applies to diabesity, as it did in the days of heavy smoking.”
In 2013 Zubair ea in India showed that diabetics with foot ulcers had vitamin D levels 1/4 of that of matched diabetics without foot ulcers; and “factors which predict the risk of developing ulcer independent of 25(OH)D status were A1c (>6.9%) [OR 4.3), neuropathy [OR 6.9retinopathy [OR 3.3;  nephropathy [OR 3.1) and smoking [OR 4.5]. It is not clear whether the suppression of delayed wound healing seen during 25(OH)D deficiency is a secondary effect or is a direct action of vitamin D on certain components of the immune system.”  

Tiwari, Singh, Swain  ea at Hindu Universities Uttar Pradesh,India have shown elegantly in                          

    *2012 Tiwari ea   Vascular calcification in diabetic foot and its association with calcium homeostasis.      Vascular calcification (VC), long thought to result from passive degeneration, involves a complex process of biomineralization, frequently observed in diabetes and an indicator of diabetic peripheral vascular disease.. ..In  74 patients with diabetic foot ulcer,   Vascular calcification was present in 42% of patients. Significant difference in vitamin D, HbA1C, and eGFR  levels was observed in VC +ve compared to VC -ve.  Severe vitamin D deficiency was more common in VC +ve (51%) compared to in VC -ve (18%). Sub-group analysis showed that the risk of VC was significantly higher (RR = 2.4, P < 0.05) in patients with vitamin D < 10 ng/ml compared to others. .and        

     * Br J Nutr. 2013. Tiwari  ea  Prevalence and severity of vitamin D deficiency in patients with diabetic foot infection.   In Diabetic Patients with and without  infection (n289), 25(OH)D (nmol/l) was significantly lower (16) v. 20ng/ml  P < 0·001) in cases than in controls. Risk of severe vitamin D deficiency (25(OH)D < 10ng/ml) was significantly higher in cases than in controls (OR 4·0, P < 0·0001). Age, duration of diabetes and HbA1c were significantly higher in cases than in controls and therefore adjusted to nullify the effect of these variables, if any, on study outcome. The study concluded that vitamin D deficiency was more prevalent and severe in patients with diabetic foot infection. ;  and the need for vitamin D supplementation in such patients for a better clinical outcome

*.in  Br J Nutr.. 2014 Tiwari ea  show Vitamin D deficiency is associated with inflammatory cytokine concentrations in patients with diabetic foot infection  . Vitamin D is a potent immunomodulator and  a common deficiency  in different population groups including patients with diabetic foot infection.   in 112 diabetic foot infection cases and 109 diabetic controls , cases had significantly higher concentrations of IL-6 (P≤ 0.001), IL-1β and TNF-α (P≤ 0.006) than controls. Risk of severe vitamin D deficiency (25(OH)D <10ng/ml) was significantly higher in cases than in controls (OR 4·0, P < 0·0001). A significant negative correlation was also observed between 25-hydroxyvitamin D concentration and circulating concentrations of IL-1β (r -0.323; P≤ 0.001) and  IL-6 but not between 25-hydroxyvitamin D and TNF-α and IFN-γ concentrations.

 

This year  2016     Wukich , Sadoskas  ea. University of Pittsburgh & Georgetown USA  in Diabetes Metab Res Rev.  show that (Charcot) neuroarthropathy (CN) of the ankle and hindfoot  is challenging to treat surgically or nonsurgically. Deformities associated with ankle/hindfoot CN are often multiplanar, resulting in  malalignment; and  shortening of the limb often occurs from collapse of the distal tibia, and ankle, with  significant alterations in the biomechanics of the foot. eg predisposing the patient to lateral foot ulceration. Collapse of the talus, secondary to avascular necrosis or neuropathic fracture, further accentuates these deformities and contributes to a limb-length inequality   CONCLUSION:  Surgical reconstruction of ankle and hindfoot CN is associated with a high rate of infectious and noninfectious complications. Preoperative measures that can improve outcomes include assessment of vascular status, optimization of glycemic control, correction of vitamin D deficiency and cessation of tobacco use. 

Now 2016 Basit A,  Malik RA5 ea in  Universities Karachi Pakistan & Manchester UK ,  show that A single intramuscular dose of 600000IU vitamin D in  143 participants with predominantly type 2 diabetes, aged ~ 52.3years, with high Douleur Neuropathique 4 (DN4) score  by  20weeks gave significant increase in 25(OH)D (from 31.7 to 46.2±10.2ng/mL, p<0.0001) and  significant  reduction (p<0.0001)  in positive symptoms on the DN4 , and total pain score (p<0.0001, The Basit – Malik Pakistan-Manchester paper showing great efficacy of 600 000iu vit D3 load dose in peripheral neuropathy diabetics matches the huge 40% improvement benefit of similar loading and monthly vit D3 dose against severe PTB shown by Salahuddin ea in Pakistan in 2013 http://www.ncbi.nlm.nih.gov/pubmed/23331510 that we have previously analyzed in this column

ie  apart from smoking; the very low vitamin D levels common in most but especially ill people  associate   with about 5 fold  risks of uncontrolled diabetes, infections,  retinopathy , progressive leg ulcers, peripheral neuropathy  and arthritis- Charcot arthroneuropathy- -and thus  gangrene and amputation; and vigorous safe (supraphysiological) vit D boost reverses the risks. .

 

And a reminder that a 2015 study in Cape town from Coussens ea Universities in W Cape and Penn State confirm what we see daily in practice, that vitamin D deficiency is endemic  in our population

 

while as we have pointed out repeatedly, the State here continues to dispense the inferior vitamin D2 (as the fraudulently labeled “strong calciferol”, not disclosing that it is ergocalciferol  D2) despite this plant xenohormone vit D2 having been rejected by world authorities in favour of the much cheaper and effective  human D3 cholecalciferol.

 

 

       And now 2016 Cadegiani , Brasilia, Brazil another  landmark massive-vit D dose report ;  Remission of Severe Myasthenia Gravis After Massive-Dose Vitamin D Treatment.Vitamin D has been shown to be related to autoimmune diseases, such as multiple sclerosis and psoriasis. Correlations have been reported between vitamin D levels and prevalence and severity of other autoimmune disorders, and also between vitamin D therapy and disease improvement and remission. This reports a patient with severe and refractory myasthenia gravis (MG) who followed a massive-dose treatment (80,000 to 120,000 IU/day) promoted by a medical center in Brazil  (Coimbra ea) and she had her first complete remission after this type of treatment  for at least 18 months (ie at least 50 million iu) with increased vitamin D serum levels (400 to 700 ng/mL) and major fall in her AChR antibodies – but acute relapse when vit D was inadvertently stopped and her vit D level halved; with again recovery when megadose vit D was resumed  CONCLUSIONS: This case may reinforce the reported correlation between vitamin D level and disease severity and introduces a possible new use for vitamin D as a potential target for treating autoimmune diseases. We recommend large, double-blind, placebo-controlled, randomized studies using high-dose vitamin D treatment for refractory autoimmune diseases to reliably assess this pharmacotherapy target for these diseases

 

     The above case concurs with previous reported massive dose daily vitamin D3: Finamor , Coimbra ea , Universities of Brazil  2013 A pilot study assessing the effect of prolonged administration of high daily doses of vitamin D on the clinical course of vitiligo and psoriasis. Autoimmunity has been associated with vitamin D deficiency and resistance, with gene polymorphisms related to vitamin D metabolism frequently described. High doses of vitamin D3 may conceivably compensate for inherited resistance to its biological effects. Nine patients with psoriasis and 16 patients with vitiligo received vitamin D3 35,000 IU once daily for six months ie ~7million iu  in association with a low-calcium diet (avoiding dairy products and calcium-enriched foods like oat, rice or soya “milk”) and hydration (minimum 2.5 L daily).. After treatment 25(OH)D3 levels significantly increased (from ~15 to 106-132ng/mL. PTH and 25(OH)D3 serum concentrations correlated inversely. The PASI score significantly improved in all nine patients with psoriasis. Fourteen of 16 patients with vitiligo had 25-75% repigmentation. Serum urea, creatinine and calcium (total and ionized) did not change and urinary calcium excretion increased within the normal range. High-dose vitamin D3 therapy may be effective and safe for vitiligo and psoriasis patients.

 

 

     neurologist Prof Dr Cicero Coimbra from Univ Sao Paulo  presents their results since 2002 in over 4000 pts ( 1000 patients each with multiple sclerosis and Parkinson’s diseases), who have been well controlled without other therapies,  provided the dose is high enough- 10 000iu/d up to about 1000iu/kg/d eg >70 000iu/d for the obese, on a low calcium ie low dairy/peanuts diet, high fluid intake and high exercise, to normalize blood calcium,  and titrate  PTH level to  the low normal range. Dr Cicero Coimbra discusses  high dose vitamin D toxicity: https://www.youtube.com/watch?v=Vxwk-YPrx7o&feature=youtu.be. PTH level should not be completely suppressed. In their clinic ( of 7 doctors)  for Autoimmune chronic diseases incl MS, RA, SLE, psoriasis, vitiligo, type 1 diabetes ,  they have treated over 4500 pts on this high quality vit D3 high fluid  low calcium diet  protocol, with only 14 cases of reversible vitamin D toxicosis (hypercalcemia) so far detected ie 0.3%. Babies of mothers thus treated in pregnancy  have high psychomotor development. (Vitamin C supplement should not be concurrently excessive to avoid oxalosis). They define success as being disease-free or non-progressive old fixed disabilities- 95% reach full cure. There vit D3 therapy  costs only ~US $20/mo, to optimize the immune system against both infections and autoimmune disease let alone cancer. Optimal dose of vit D3 replacement becomes at least 10 000iu/day for adults especially with autoimmune diseases  due to common vitamin D resistance. Ideally testing baseline blood and urine at baseline and after a few months on at least 10 000iu/d.

 

 

     In Effect of a single oral dose of 600,000 IU of cholecalciferol on serum calciotropic hormones in young subjects with vitamin D deficiency:. 2010. Cipriani ,Minisola ea .University of Rome  Italy tested    48 young subjects with vitamin D deficiency with a single oral dose of 600,000 IU of cholecalciferol. The 25(OH)D level was ~15.8ng/ml at baseline and became ~77ng/ml at 3 d (P < 0.001) and ~62 ng/ml at 30 d (P < 0.001). The trends were maintained in a subgroup followed up to 90 d (P < 0.001). Mean serum Ca and P significantly increased compared to baseline, whereas serum Mg decreased at 3 d. CONCLUSIONS: A single oral dose of 600,000 IU of cholecalciferol rapidly enhances 25(OH)D and reduces PTH in young people with vitamin D deficiency.

 

       Looking at some new alarmist myth refs about vit D3 overdose :

Moderate  ie physiological increase in just vitamin D levels and intake  (from average diet and sunshine and a traditional supplement) within the average population bloodlevel range understandably has modest  benefit- reversing at least rickets-  in an  indoor living clothed population, even  1st world middleaged:  from Wisconsin Univ, Karen Hansen ea’s recent RCT – JAMA 2015- Treatment of Vitamin D Insufficiency in Postmenopausal Women confirmed this, showing little practical benefit shortterm (ie over 12mo) between placebo, and supplemented vit D3  5600iu/wk and 25000 iu a week, (~3600iu/d);  the highest dose perhaps doubling the baseline 20ng/ml  25OH vit D level. ie into the low “adequate” range average around 40ng/ml.

Be aware again that  the same university’s group published in 2014   An Evaluation of High-Dose Vitamin D 2  for Rheumatoid Arthritis Karen Hansen ea that vit D2 ~100 00iu/month  for a year actually worsens patients and lowers vit D3 levels  , so there is no longer excuse for using vitamin D2 supplement when it blocks D3 receptors and lowers blood vit D3.

The inferiority of vit D2 was confirmed in eg    Clinical Trial of Vitamin D2 vs D3 Supplementation in Critically Ill Pediatric Burn Patients.  Gottschlich, Kagan U Cincinnati Ohio 201550  patients  aged 1 to 18yrs with burns  were enrolled. All participants received multivitamin supplementation ,  plus , 100 IU/kg D2, D3, or placebo daily  RESULTS: There were no significant differences in serum vitamin D levels between groups, but >10% of patients had low 25OHD  at discharge, and %deficiency worsened by the 1-year follow up for the placebo (75%), D2 (56%), and D3 (25%) groups. There were no statistical differences in clinical outcomes between treatment groups, although vitamin D supplementation demonstrated clinically relevant decreases in exogenous insulin requirements, sepsis, and scar formationThe high incidence of low serum 25OHvit D levels 1 year following serious thermal injury indicates prolonged compromise. Continued treatment with vitamin D3 beyond the acute phase postburn is recommended to counteract the trajectory of abnormal serum levels and associated morbidity. 

The perception seems to be that up to 40 000iu vit D3 a day, a bld level below abt 150-350ng/ml  is safe, ie unsafe above that. The evidence for such ceiling ie  higher dose harm in fact is lacking since as we have previously discussed here,  healthy people have taken up to 150 000iu a day for decades without evidence of harm…  provided they took adequate fluids, and did not take supplements of calcium, or also take high  vitamin A which notoriously causes acute hypercalcemic toxicity, or have rising calcium levels . .

But note that vit K2 improves absorption of vit D3 CHOLECALCIFEROL , and vit K2 and magnesia improve benefit of vit D3,while protecting against overdose effects ie calcification, stones  and confusion.  Problem in many  toxicity reports is that they used either vit D2 ergocalcif (WHICH BLOCKS THE NEEDED D3) , or used accidental massive overdose (millions of units vit D ) daily for months- or massive INJECTIONS) or combined vit D WITH CALCIUM REPLACEMENT AND/ OR EXCESSIVE VITAMIN  A  – which combinations are  dangerous;  we need magnesium (not calcium  or high vitamin A supplements).

    Vitamin D3: What’s the Latest? recent 2015 reviews from  Univ California and CommonHealth contrast the Instit Medicine IOM (Big-Pharma-sponsored)  conservative target of  vit D3 800 to max 4000iu/d with much evidence that safe optimal D3 dose may be up to 10 000 to 50 000iu/d, and up to  1 000 000iu as an acute eg antiinfection  loading dose; with risk of toxicity only if blood level exceeds 150-500ng/ml. the evidence-based IOM recommendation of optimal blood level 20-40ng/ml, up to 2000iu a day promoted by conservatives like Prof JoAnn Manson, contrasts with the more proactive view of eg Prof Michael Hollick and the Vitamin D Council promoting double that dose as supplements, safely up to 10 000iu/day.

 

   SO  I continue to take vit D3 ~70 000iu/wk ie ~10 000iu/d,  with vit K2 supp ~700mcg a wk ie 100mcg/dy and a balanced multisupplement incl. magnesia in addition to a multisupplement A-Z, and fish oil and Lugols iodine 15% 2 drops a day; with if I do get a “flu” attack during bad weather, prompt abolition by a few antibiotic doses of topup Lugols iodine 15% a few tsp (ie ~1000mgs iodine),  and vitamin D3 eg 300 000iu, and vitamin C a few tsp orally and by sniffing. .

The problem with many adverse effect reports of vit D3 overdose eg the Dominican Republic Soladek  2011 report Lowe ea below, and Prof Heaney’s response,  is that they failed to even consider the massive associated  overdose of the far more hypercalcemic vitamin A let alone calcium supp reported by most  patients. It becomes apparent that NO calcium supplement should be encouraged on a prudent diet; but instead supplements of  Vit D3, magnesia, vits K2 and C, CoQ10, and fish oil ; in addition to a balanced (A to Z) RDA-based multisupplement for seniors  like eg Solal’s,  Vital’s Multitime, Centrum etc.. with a low calcium diet if massive dose vitamin D3 is indicated as in autoimmune diseases (Coimbra ea).

Ndb

APPENDIX: RECENT REFS:
VITAMIN D ANABOLIC STEROID ABUSE IN SPORT?

the Australian Govt  Supplement Overview   has an intriguing report on vit D in sports, with no hint of vit D supplement being a steroid abuse. .http://www.ausport.gov.au/data/assets/pdf_file/0003/594174/CORP_33413_SSF_Vitamin_D_FS.pdf        Vitamin D is classified as a fat soluble vitamin which acts functionally as a steroid hormones. There are 2 different isoforms of Vitamin D: D3 (cholecalciferol) which is the important isomer formed in human   skin and D2 (ergocalciferol) which is the plant-derived ie xeno-equivalent. D2 was the first isoform to be characterised   and was first used in Vitamin D supplements and for food fortification. D3 is now considered preferable. D3 is   biologically inert until converted in the liver to 25(OH)D and to 1,25(OH)D in the kidney.  Vitamin D plays an important role in calcium and phosphorous homeostasis (bone health),but more so in  gene expression and cell growth. The recent recognition of Vitamin D receptors in most body tissues indicates a role for Vitamin D in  many aspects of health and function. Vitamin D is now known to be important for optimal muscle function.

         The principal source of circulating vitamin D comes from exposure to ultraviolet B (UVB) radiation from sunlight.   In 2010, the Institute of Medicine issued new Dietary Reference Intakes for Vitamin D, assuming no sunlight exposure: this included a Recommended Dietary Intake of 600 IU/d and an Upper Level intake of 4000 IU/d  (www.iom.edu/vitamind). BUT no evidence has ever been published to support this ceiling intake.

Whereas Vitamin D deficiency can lead to several health issues including increased risk of bone injuries, chronic musculoskeletal pain and viral respiratory tract infections. There is also emerging evidence that supplementing Vitamin D in athletes with sub-optimal Vitamin D levels may   have beneficial effects on athletic performance in particular strength, power, reaction time and balance.

         There is no universally accepted definition of vitamin D deficiency however, the following definitions based on  serum levels of 25(OH) Vitamin D are often cited:

Vitamin D deficiency: serum levels < 20 ng/ml (50 nmol/L);  Vit D insufficiency: serum levels < 30 ng/ml

Vit  D sufficiency: serum levels > 30 ng/ml    Ideal Vit D range*: 30-50ng/ml 

Toxicity: > 150ng/ml, when combined with raised serum calcium

(*Higher status may be preferred for athletes to allow a greater safety margin and to optimize performance;   some agencies working with elite athletes often set their own thresholds for desired Vitamin D concentrations)

Ie they quote no evidence for the 25OH vit D ceiling of 50ng/ml.

 

Confirmed in

  Owens DJ1, Close GL ea .  UK Universities  . 2015..A systems-based investigation into vitamin D and skeletal muscle repair, regeneration, and hypertrophy. Skeletal muscle is a direct target for  vitamin D. Observational studies suggest that low 25[OH]D correlates with functional recovery of skeletal muscle following eccentric contractions in humans and crush injury in rats. However, a definitive association is yet to be established. To address this gap in knowledge in relation to damage repair, a randomised, placebo-controlled trial was performed in 20 males with insufficient concentrations of serum 25(OH)D (~18ng/ml). Prior to and following 6 wk of supplemental vitamin D3 (4,000 IU/day) or placebo (50 mg of cellulose), participants performed 20 × 10 damaging eccentric contractions of the knee extensors.  Supplemental vitamin D3 increased serum 25(OH)D and improved recovery of peak torque at 48 h and 7 days postexercise. Together, these preliminary data are the first to characterize a role for vitamin D in human skeletal muscle regeneration and suggest that maintaining serum 25(OH)D may be beneficial for enhancing reparative processes and potentially for facilitating subsequent hypertrophy.

 

2016 Is there an optimal vitamin D status for immunity in athletes and military personnel?  He CS1, Gleeson M ea .Vitamin D is mainly obtained through sunlight ultraviolet-B (UVB) exposure of the skin, with a small amount typically coming from the diet.It is now clear that vitamin D has important roles beyond its well-known effects on calcium and bone homeostasis. Immune cells express the vitamin D receptor, including antigen presenting cells, T cells and B cells, and these cells are all capable of synthesizing the biologically active vitamin D metabolite, 1, 25 hydroxy vitamin D.There has been growing interest in the benefits of supplementing vitamin D as studies report vitamin D insufficiency (circulating 25(OH)D < 50 nmol/L) in more than half of all athletes and military personnel tested during the winter, when skin sunlight UVB is negligible. The overwhelming evidence supports avoiding vitamin D deficiency (25(OH)D< 30 nmol/L)to maintain immunity and prevent upper respiratory illness (URI) in athletes and military personnel.Recent evidence supports an optimal circulating 25(OH)D of 75 nmol/L to prevent URI and enhance innate immunity and mucosal immunity and bring about anti-inflammatory actions through the induction of regulatory T cells and the inhibition of pro-inflammatory cytokine production. We provide practical recommendations for how vitamin D sufficiency can be achieved in most individuals by safe sunlight exposure in the summer and daily 1, 000 IU vitamin D3 supplementation in the winter.

 

Sarris J1, Ng CH1. Ea, Universities  of Melbourne, & Deakin, Australia;  &  Harvard Boston; 2016  show in   Adjunctive Nutraceuticals for Depression: A Systematic Review and Meta-Analyses. http://www.ncbi.nlm.nih.gov/pubmed/27113121  Adjunctive  standardized pharmaceutical-grade nutrients, known as nutraceuticals, has the potential to modulate several  neurochemical pathways implicated in depression. A systematic search up to 2015 for clinical trials using adjunctive nutrients for depression    RESULTS: Primarily positive results were found for studies testing S-adenosylmethionine (SAMe), methylfolate, omega-3 (primarily EPA or ethyl-EPA), and vitamin D,.  Mixed results were found for zinc, folic acid, vitamin C, and tryptophan. . No major adverse effects were noted in the studies  adjunctive omega-3 versus placebo revealed a significant and moderate to strong effect in favor of omega-3. CONCLUSIONS: Current evidence supports adjunctive use of SAMe, methylfolate, omega-3, and vitamin D with antidepressants to reduce depressive symptoms.

Raina AH1, Bhat FA1 ea ., India.. 2016 Association of Low Levels of Vitamin D with Chronic Stable Angina: A Prospective Case-Control Study.  http://www.ncbi.nlm.nih.gov/pubmed/27114971  Coronary artery disease (CAD) is a major cause of death and disability in developed countries. Chronic stable angina is the initial manifestation of CAD in approximately 50% of the patients. Recent evidence suggests that vitamin D is crucial for cardiovascular health. The prevalence of vitamin D deficiency in our region is 83%. METHODS: a prospective case-control study in  100 cases of chronic stable angina compared controls. Vitamin D deficiency was defined as <20 ng/mL, vitamin D insufficiency as 20-30 ng/mL and normal vitamin D level as 31-150 ng/mL.RESULTS: The prevalence of vitamin D deficiency among cases and controls was 75% and 10%, respectively. 13% had normal vitamin D levels (31-150 ng/mL). None had a toxic level of vitamin D. Among the controls, 10% were vitamin D-deficient, 57% had normal vitamin D levels. The mean vitamin level among cases and controls was 15.53 ng/mL and 40.95 ng/mL, respectively, statistically significant (P ≤ 0.0001). Among the cases, we found that an increasing age was inversely related to vitamin D levels (P = 0.027). Low levels may be an independent, potentially modifiable cardiovascular risk factor.

Jetty , Glueck   Kumar  ea . Jewish Hospital Cincinnati, Ohio, USA  2016  show 12mo Safety of 50,000-100,000 Units of Vitamin D3/Week in Hypercholesterolemic  Vitamin D-Deficient,   Patients with Reversible Statin Intolerance. : http://www.ncbi.nlm.nih.gov/pubmed/27114973   Such Vitamin D3 therapy (was safe and effective when given for 12 months to reverse statin intolerance in patients with vitamin D deficiency. Serum vitamin D rarely exceeded 100 ng/mL, never reached toxic levels, and there were no significant change in serum calcium or eGFR

https://riordanclinic.org/2013/10/vitamins-d3-and-k2-the-dynamic-duo/ As we explore the healing power of higher doses of vitamin D3 at the Riordan Clinic, we have found it prudent to partner the safety and effectiveness of this dynamic duo. For every 5,000–10,000 units of D3 being recommended and tested for, we are recommending 100 mcg of K2 mk7 to be sure and prevent the inappropriate calcification that higher doses of D3 alone could cause.

http://www.amazon.com/MIRACULOUS-RESULTS-EXTREMELY-SUNSHINE-EXPERIMENT-ebook/dp/B005FCKN2S#reader_B005FCKN2S     is a recent book by Jeff T Bowles .

 Newsletter: Gary Null and vitamin D toxicity    2010 by John Cannell, MD http://www.vitamindcouncil.org/newsletter/newsletter-gary-null-and-vitamin-d-toxicity/     “Warning: If you intend to take massive doses of vitamin D based on this newsletter, which I highly recommend you do not, read the entire newsletter. In addition, accurate determination of side effects of massive doses of vitamin D was not available in the early 1930s, nor was accurate determination of the true amount in each pill possible.    Is 2,000,000 IU/day of vitamin D toxic?   Ask Gary Null, alternative medicine guru and entrepreneur. He took his own supplement, Ultimate Power Meal, for a month and became extremely ill; one batch of Power Meal apparently contained 1,000 times more vitamin D than it should. That is, it contained 2,000,000 IU of vitamin D3 per serving instead of 2,000 IU per serving. Mr. Null became sicker and sicker as he gulped it down.

After suing his own supplier for permanent physical damage, Mr. Null then reported it took 3 months to get the extra vitamin D out of his system and that he is now alive and well. If Mr. Null took it for the full month that he claims, and if his Power Meal contained 2,000,000 IU per dose, Mr. Null consumed 60,000,000 IU in one month. Could he really be fine now with no lasting injuries?  In an attempt to answer that question, I went back to the 1930s and 40s.  Massive doses in the 1930s  The earliest references I could find to enormous doses of vitamin D were in the 1930s. In 1935, Drs. Dreyer and Reed, of the University of Illinois School of Medicine, published their observations on 700 patients treated with “massive” doses of vitamin D for up to two years.1  ….” read on..http://www.vitamindcouncil.org/newsletter/newsletter-gary-null-and-vitamin-d-toxicity/ http://www.livescience.com/50765-vitamin-d-supplements-toxicity.html

Vitamin D Overdose   Dr. Liji Thomas, MD  2016  http://www.news-medical.net/health/Vitamin-D-Overdose.aspx   vitamin D toxicity can occur from high intakes of supplements containing vitamin D, but not from dietary intake. Prolonged sun exposure also does not result in vitamin D toxicity because the previtamin D3 is degraded as the skin heats up, and also because of the formation of various other non-functional forms of vitamin D from the thermally activated compound.   Long term intakes of vitamin D above the upper limit recommended causes symptoms of toxicity. However, the intakes must be higher than about 40,000 IU/day, or the serum level of 25-hydroxy above 500-600 ng/mL, and the patient is usually also taking excessive amounts of calcium as well.

Dietary Supplement–Induced Vitamin D Intoxication  Klontz KC, Acheson DW.  To the Editor 2004:    Vitamin D intoxication that is associated with the consumption of dietary supplements is reported rarely. In 2004, the Food and Drug Administration (FDA) learned of the following case. A 58-year-old woman with diabetes mellitus and rheumatoid arthritis began taking a dietary supplement called Solutions IE Ageless Formula II on January 12, 2004. Fatigue, constipation, back pain, forgetfulness, nausea, and vomiting soon developed. On March 15, 2004, she was hospitalized because her speech was slurred, and a blood glucose reading taken at home was 30 mg per deciliter. On admission, her serum levels were as follows: calcium, more than 3.75 mmol per liter; 25-hydroxyvitamin D, 460ng/ml (normal range, 9-5);; parathyroid hormone, 12 ng per liter (normal range, 10 to 65); and creatinine, 265 μmol per liter.   The patient was treated with intravenous normal saline, furosemide, and pamidronate. On March 19, 2004, while still hospitalized, she was informed by the product distributor of an error in product formulation such that 188,640 IU of vitamin D3/d  had been added to the daily serving size of six capsules instead of the intended 400 IU. IE SHE HAD TAKEN ~12.2MILLION IU OF VIT D3 IN 2 MONTHS. At discharge on March 24, the patient’s serum levels were as follows: calcium, 2.60 mmol per liter; blood urea nitrogen, 10.0 mmol per liter; and creatinine, 221 μmol per liter. The patient died from a cause unknown to us on January 8, 2005.   Laboratory analysis of the product by the FDA, obtained from one of two lots reportedly overfortified with vitamin D3, revealed 186,906 IU of vitamin D3 in each serving size of six capsules, indicating that the patient had consumed roughly 90 times the recommended safe upper limit of 2000 IU per day. Long-term daily vitamin D consumption of more than 40,000 IU (1000 μg) is needed to cause hypercalcemia in healthy persons.2     In March 2004, the product distributor announced that during the previous month it had received three complaints from customers who had been hospitalized for hypercalcemia and vitamin D toxicity

2011 Vitamin D toxicity due to a commonly available “over the counter” remedy from the Dominican Republic. Lowe H1, Bilezikian JP. ea  Columbia Univ, NY.. http://press.endocrine.org/doi/10.1210/jc.2010-1999?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&   Hypercalcemia in ambulatory patients is occasionally caused by vitamin D toxicity. We report nine patients presenting to Columbia University Medical Center with hypercalcemia due to a supplement from the Dominican Republic containing massive amounts of vitamin D. All reported recently taking Soladek readily available in the Dominican Republic and in Upper Manhattan. serum calcium values before the ingestion of Soladek were not elevated  According to the manufacturer’s label, each 5-ml vial of Soladek contains vitamin D3 (600,000 IU), vitamin A (120,000 IU), and vitamin E (5 mg). Laboratory analysis by HPLC revealed that the supplement actually contained vitamin D(3) (864,000 IU) and vitamin A (predominantly retinyl palmitate 123,500 IU) per vial.IE 864000 IU VIT D /day FOR UNKNOWN DURATION. a similar case was reported earlier  http://www.thecamreport.com/2009/11/soladek-toxicity-in-a-60-year-old-woman/

Comments by Prof Robert P. Heany    Creighton University, Omaha, Nebraska  on Lowe et al:   Hypercalcemia in vitamin D intoxication JCEM   http://press.endocrine.org/e-letters/10.1210/jc.2010-1999        The report by Lowe et al. on vitamin D intoxication from an OTC supplement (1) is instructive and useful. I comment on the authors’  suggested mechanism of hypercalcemia in such cases. The authors propose that the elevated concentration of serum 25- hydroxy-vitamin D [25(OH)D] is the responsible agent, through loose binding to the vitamin D receptor. While my colleagues and I have shown that 25(OH)D can improve calcium absorption (2), I believe there is a simpler explanation for hypercalcemia in vitamin D intoxication, particularly as the reported values of 25(OH)D were not uniformly high in these nine cases. [In fact the patient with the highest serum calcium had actually the lowest value for 25(OH)D.] Instead, as Vieth suggested several years ago in a paper actually referenced by Lowe et al. (3), elevation of free circulating 1,25(OH)2D (calcitriol) is the most parsimonious explanation. This level is not commonly measured, and was not reported in the cases described by Lowe et al. Vieth has estimated the binding capacity of the D-binding protein (DBP) at approximately 4700 nmol/liter, and it is generally recognized that fewer than 5% of its binding sites are occupied at typical cholecalciferol inputs. However, in the face of huge cholecalciferol doses, as in the nine cases described here, it can easily be calculated that most or all of the binding sites on the DBP would be occupied by cholecalciferol itself as well as by 25(OH)D and 24,25(OH)2D, all of which are bound to the DBP more avidly than is calcitriol. Lowe et al. did not measure serum cholecalciferol, but it is virtually certain that its concentration would have been elevated, if for no other reason than that the capacity of the hepatic 25-hydroxylase is limited, and serum cholecalciferol concentration rises steeply for cholecalciferol inputs in excess of the saturation level of the 25-hydroxylase [which typically occurs at serum cholecalciferol levels of about 10 nmol/L and serum 25(OH)D of about 80 nmol/liter (4)].Even if all of the binding sites of the DBP were not continuously occupied by less polar metabolites, high occupancy would shift the equilibrium between the free and the bound calcitriol, so that free calcitriol concentration would likely have been substantially above normal values continuously. The authors speculate as to the origin of the elevated total calcitriol concentrations, given the down-regulation of the renal 1-á- hydroxylase in such cases. 

 

     2016.Deficient serum 25-hydroxyvitamin D is associated with an atherogenic lipid profile: The Very Large Database of Lipids (VLDL-3) study. Lupton JR1Michos  ea .  Cross-sectional studies have found an association between deficiencies in serum vitamin D, as measured by 25-hydroxyvitamin D (25[OH]D), and an atherogenic lipid profile. These studies have focused on a limited panel of lipid values including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG).OBJECTIVE: Our study examines the relationship between serum 25(OH)D and an extended lipid panel (Vertical Auto Profile) while controlling for age, gender, glycemic status, and kidney function.METHODS: We used the Very Large Database of Lipids, which includes US adults clinically referred for analysis of their lipid profile from 2009 to 2011. Our study focused on 20,360 subjects who had data for lipids, 25(OH)D, age, gender, hemoglobin A1c, insulin, creatinine, and blood urea nitrogen. Subjects were split into groups based on serum 25(OH)D: deficient (<20 ng/mL), intermediate (≥20-30 ng/mL), and optimal (≥30 ng/mL). The deficient group was compared to the optimal group using multivariable linear regression.RESULTS: In multivariable-adjusted linear regression, deficient serum 25(OH)D was associated with significantly lower serum HDL-C (-5.1%) and higher total cholesterol (+9.4%), non-HDL-C (+15.4%), directly measured LDL-C (+13.5%), intermediate-density lipoprotein cholesterol (+23.7%), very low-density lipoprotein cholesterol (+19.0%), remnant lipoprotein cholesterol (+18.4%), and TG (+26.4%) when compared with the optimal group.CONCLUSION:  Deficient serum 25(OH)D is associated with significantly lower HDL-C and higher directly measured LDL-C, intermediate-density lipoprotein cholesterol, very low-density lipoproteins cholesterol, remnant lipoprotein cholesterol, and TG

 

  1. Low-Level VitaminD Is strongly Associated with Atrial Fibrillation in Patients with Chronic Heart Failure.Belen E1, , Cetin M2ea. Atrial fibrillation (AF) freuently accompanies heart failure (HF), and causes exacerbation of symptoms and treatment failure in such patients. Vitamin D was recently suggested to be an important mediator of cardiovascular disease, including HF.OBJECTIVES: The aim of this study was to evaluate the relationship between vitamin D deficiency and AF in patients with chronic HF. METHODS: The study included 180 chronic HF patients that were divided into 2 groups based on having sinus rhythm [AF (-) group] or chronic AF [AF (+) group]. Vitamin D status was assessed via measurement of the serum 25-hydroxyvitamin D (25[OH]D) concentration.RESULTS: Mean age of the patients was 66 ± 8.7 years and 53.9% were male. There weren’t any significant differences in age, gender, body mass index, etiology or chronic HF stage between the 2 groups. The vitamin D level in the AF (+) group was significantly lower than in the AF (-) group (11.05 ng/mL vs. 20 ng/mL, p < 0.001) The left atrium to body surface area ratio (LA/BSA) was significantly higher in the AF (+) group (45.03 mm/m2 vs. 42.05 mm/m2, p < 0.01). Independent predictors (based on multiple regression) of AF were vitamin D level (OR = 0.854, 95% CI: 0.805-0.907, p < 0.001) and LA/BSA ratio (OR = 1.077, 95% CI: 1.003-1.156, p < 0.05). The optimal vitamin D cut-off value for the prediction of AF was 16.50 ng/mL, with a sensitivity of 76.0% and specificity of 65.5% (AUC = 0.75, 95% CI: 0.67-0.82).

 

Vitam Horm. 2016;100:255-71. doi: 10.1016/bs.vh.2015.10.001. Epub 2015 Nov 30. Molecular Approaches for Optimizing Vitamin D Supplementation.   Carlberg C1.Vitamin D can be synthesized endogenously within UV-B exposed human skin. However, avoidance of sufficient sun exposure via predominant indoor activities, textile coverage, dark skin at higher latitude, and seasonal variations makes the intake of vitamin D fortified food or direct vitamin D supplementation necessary. Vitamin D has via its biologically most active metabolite 1α,25-dihydroxyvitamin D and the transcription factor vitamin D receptor a direct effect on the epigenome and transcriptome of many human tissues and cell types. Different interpretation of results from observational studies with vitamin D led to some dispute in the field on the desired optimal vitamin D level and the recommended daily supplementation. This chapter will provide background on the epigenome- and transcriptome-wide functions of vitamin D and will outline how this insight may be used for determining of the optimal vitamin D status of human individuals. These reflections will lead to the concept of a personal vitamin D index that may be a better guideline for an optimized vitamin D supplementation than population-based recommendations.

 

  1. Comparative efficacy of vitamin D status in reducing the risk of bladder cancer: A systematic review and network meta-analysis.Zhao, , Huang J3. The optimal concentration of individual vitamin D intake for preventing bladder cancer has not, to our knowledge, been defined. To evaluate the comparative efficacy of different serum 25-hydroxyvitamin D concentrations in preventing bladder cancer, we conducted a systematic search of the literature published up to April 2015.METHODS: We applied a pairwise meta-analysis to estimate direct evidence from intervention-control studies and a network meta-analysis within a Bayesian framework to combine direct and indirect evidence. Moreover, a dose-response curve was utilized to predict the optimal median serum 25-hydroxyvitamin D concentration based on the odds ratio (OR) for each quintile concentration.: Seven studies of a total of 90757 participants, including 2509 bladder cancer patients, were included. Two prospective cohort studies with 57 591 participants and 494 bladder cancer patients, and five case-control studies with 33 166 participants and 2264 bladder cancer patients. From the network meta-analysis, we observed that sufficient serum 25-hydroxyvitamin D concentrations (>75 nmol/L) were superior to all other 25-hydroxyvitamin D concentrations in decreasing the risk of bladder cancer: OR = 0.68 and 95% credible interval (CrI) 0.52 to 0.87 compared with severely deficient concentrations (<25 nmol/L); OR = 0.65 and 95% CrI 0.49 to 0.86 compared with moderately deficient concentrations (25-37.5 nmol/L); OR = 0.61 and 95% CrI 0.47 to 0.80 compared with slightly deficient concentrations (37.5-50 nmol/L); and OR = 0.65 and 95% CrI 0.48 to 0.85 compared with insufficient concentrations (50-75 nmol/L). In addition, we noted a roughly inverse correlation between bladder cancer risk and 25-hydroxyvitamin D concentrations (R(2) = 0.98, P = 0.007).CONCLUSIONS:   Ensuring sufficient serum 25-hydroxyvitamin D concentrations might play an important role in decreasing the risk of bladder cancer. The serum 25-hydroxyvitamin D concentration ≥30ng/ml  was associated with a 60% lower risk of bladder cancer incidence.

the Ides of March 2016:  Where have we been the past 5 years in ignoring the crucial role of K2 supplement  with vit D3? against cancer, fractures, infections, vascular disease and diabetes , 

      like the crucial role of Lugols iodine + selenium, and magnesium (not calcium), coQ10, and animal, marine and coconut ie saturated fat oil- supplement  for all chronic disease prevention?

     Considering that our western processed food staple diet, and the diet of the poor majority everywhere,  is increasingly deficient especially in these nutrients,  with by profit-motivated industrial design  disease-promoting cholesterol-depletion, refined sugars, transfats, antibiotics, hormones,  and noxious at-any-dose elements from fluorine and aluminium upwards.

 

I see I was  promoting K2 in my emails 4 years ago,  and since 2009, on my Healthspanlife blog  ie in  my lectures  and thus in my healthspanlife blends .

     But  I indeed don’t seem to have published a review of K2 on my blog- till now!
– and there are so many refs out there since the first K2 mention on Pubmed in 1946,
and its first Pubmed  human supplement mention in 2002  Improvement with maternal supplement of vitamin K2  of vitamin K status of breastfeeding infants  (MK40).  Nishiguchi T, Terao T ea.   Semin Thromb Hemost. 2002 : 28533-8.

Unlike the Big Pharma-Disease-Industry- controlled denialists of conservative safe  natural phamacological vitamin therapy  like the   Linus Pauling Institute   and   Wikipedia                 https://en.wikipedia.org/wiki/Vitamin_K2,

the vitamin  K2 Polish scientist Dr Katarzyna Maresz PhD     2015 writes (see abstract below)  Proper Calcium Use: Vitamin K2 as a Promoter of Bone and Cardiovascular Health.  Maresz K1. International Science and Health Foundation Krakow, Poland    Inadequate calcium intake can lead to decreased bone mineral density, thus  increase the risk of bone fractures. Recent scientific evidence, however, suggests that elevated consumption of calcium supplements may raise the risk for heart disease and can be connected with accelerated deposit of calcium in blood-vessel walls and soft tissues. In contrast, vitamin K2 is associated with the inhibition of arterial calcification and arterial stiffening. Dosing of K2 was supported by a population-based study with 16 000 healthy women aged 49 to 70 years drawn from EPIC’s cohort population. After 8 years ,it showed that a high intake of natural vitamin K2 (ie, not synthetic K2, but not of vitamin K1) was associated with protection against cardiovascular events. For every 10 mcg of dietary vitamin K2 consumed (in the forms of menaquinone 7 (MK-7), menaquinone 8 (MK-8), and menaquinone 9 (MK-9), the risk of coronary heart disease was reduced by 9%. … The researchers found that a daily dose of 180 mcg was enough to improve bone mineral density, bone strength, and cardiovascular health. They also showed that achieving a clinically relevant improvement required at least 2 years of supplementation.
      While vit D3  cholecalciferol soltriol  was the multiprevention megavitamin   of the past decade, and CoQ10 the decade before that, catching up with the protean benefits of increasingly diet- deficient vitamins published (350 000 Pubmed citations) the past century, and of vitamin K since 1936, and K2 since 1946,
vit K2 is the most publicized ie advancing megavit of the current decade:
Adequate intake ie ~45 to ~150mcg/d is crucial with magnesium, boron etc to balance vigorous  vit D3 supplement,
for both bone, immune/cancer, and cardiovascular health.
Thus even just ~55mcg/d K2 supplement HALVES the risk of cardiovascular disease – very important in overweight/stressed/ aging people. 

BUT The authorities quoted have assessed safety and optimal longterm effective doses of vitamin K3 and vitamin D3 IN ISOLATION  for major prevention. However, we know that optimal nutrition is balanced nutrition, not one or two nutrient is superdose with an average fastfood mediocre diet. 

This finally convinces me to add vit K2 ~ 35 to 100mcg/day ie 200 to 700mcg/wk  to my own  vit D3 supplements. at a trivial bulk wholesale cost of  ~10mg/d 1% K2 ie ~R0.1/day or R14 – ( US$1)   bag  per 40 weeks of vit D3 @ 50 000iu vit D3 twice a month.

Like  Mercola 2010  http://articles.mercola.com/sites/articles/archive/2010/08/26/this-could-be-even-bigger-than-the-vitamin-d-discovery.aspx,             Byron Richards already in 2010 wrote a major review promoting K2 multipurpose: http://www.wellnessresources.com/health/articles/vitamin_k2_bones_cardiovascular_health_blood_sugar_control_cancer_prev/

As a recent BBC review   details,    “Vitamin K1 has a relatively short half-life and is rapidly cleared from the blood  by the liver within eight hours. In comparison vitamin K2 has a longer half-life of up to 72 hours, meaning it remains biologically active in the body for longer.   Vitamin K2 is also absorbed better by the body, and is linked to cardiovascular health. It directs calcium to the bones, and prevents it from being deposited where it shouldn’t be, for example arteries and organs, where it can cause harm.

The Kansas Riordan Clinic  promotes the Superhuman Duo  of D3+K:   they point out that ” Because an accurate LD50 for vit D in humans has never been determined (thank God!) most researchers use the LD50 for dogs as an estimate for humans, using a hypothetical human subject weighing  50kg, 110 pounds: in order to reach the LD50 dose, that subject would need to consume over 3,500 of the 50,000 IU D3 caps in a 24 hour period (146 capsules an hour,  total  175million iu) in order to have a 50% chance of dying. By conscientiously using vitamin K2 in conjunction with D3, this issue of “metastatic calcium” is thoroughly avoided.  Finally, like vitamin D3, strong evidence demonstrates vitamin K’s amazing ability to reduce cancer risk. For example, men taking vitamin K2 mk7 (a naturally occurring long acting form of K2) at 45 mcg a day can statistically reduce their risk of prostate cancer by 60%! That is just one of many cancer risks that are reduced significantly by regular K2 ingestion.      As we explore the healing power of higher doses of vitamin D3 at the Riordan Clinic, we have found it prudent to partner the safety and effectiveness of this dynamic duo. For every 5,000–10,000 units of D3 being recommended and tested for, we are recommending 100 mcg of K2 mk7 to be sure and prevent the inappropriate calcification that higher doses of D3 alone could cause.

            For the safety of vigorous dose of vitamin D3, the masses of D3  evidence we assembled by August 2015   is that 2million units as a single oral dose does no harm to nonagenarians, nor has over 100 000iu a day for 28 years ie over a billion  iu  in middle-aged women.  

 In 2015,    Like *Joe Leech                                          and             *Hogne Vik   ,                                                    *Angela Pifer nutritionist notes the essensiality of balancing vit D3 with K2  “Vitamin D3 should never be taken alone. Always take a combination Vitamin D3/ Vitamin K2 liquid emulsion, at night for best absorption. This is because vitamin D3 improves calcium absorption across the GI tract and vitamin K2 is the cofactor needed to transfer calcium into your bones, and not your arteries.   (Eur J Clin Nutr. 2016 Feb 24. doi: 10.1038/ejcn.2016.3. Steady-state vitamin K2 (menaquinone-7) plasma concentrations after intake of dairy products and soft gel capsules.   KnapenVermeer  ea . Maastricht University, Netherlands.   In a previous human intervention study, we observed an improved vitamin K status after 8 weeks of intake of a yogurt  fortified with vitamin K2 (as menaquinone-7, MK-7) and vitamins C and D3, magnesium and polyunsaturated fatty acids. It was hypothesized that the added nutrients contributed to this improvement. Here we report on a study in which we compared the fasting plasma concentrations of MK-7 from (a) yogurt enriched with MK-7, vitamins D3 and C, magnesium, n-3 poly unsaturated fatty acids (n-3 PUFA) and fish oil (yogurt Kplus), (b) yogurt fortified with MK-7 only (yogurt K) and (c) soft gel capsules containing only MK-7, For 42 days in healthy men and postmenopausal women between 45 and 65 years of age daily consumed either yogurt K, yogurt Kplus or capsules.  RESULTS: The increase in plasma MK-7 with the yogurt Kplus product was more pronounced than the increase in MK-7 with the capsules, reflecting vitamin K status improvement. No significant differences in fasting plasma concentrations of various biomarkers between the yogurts were found.   CONCLUSIONS: Dairy matrix and nutrient composition may affect MK-7 delivery and improvement of vitamin K status. Yogurt fortified with MK-7 is a suitable matrix to improve the nutritional status of the fat-soluble vitamins.)

Some recent of the other 5000 K2 refs on Pubmed, apart from the abundant reviews by Garry Gordon, Joe Mercola, Mike Howard, Jeff Dach, Townsend letter, ea  , are

Integr Med (Encinitas). 2015;14; 34-9.  Proper Calcium Use: Vitamin K2 as a Promoter of Bone and Cardiovascular Health.  Maresz K1. International Science and Health Foundation Krakow, Poland    Inadequate calcium intake can lead to decreased bone mineral density, thus  increase the risk of bone fractures. Supplemental calcium promotes bone mineral density and strength and can prevent osteoporosis. Recent scientific evidence, however, suggests that elevated consumption of calcium supplements may raise the risk for heart disease and can be connected with accelerated deposit of calcium in blood-vessel walls and soft tissues. In contrast, vitamin K2 is associated with the inhibition of arterial calcification and arterial stiffening. An adequate intake of vitamin K2 has been shown to lower the risk of vascular damage because it activates matrix GLA protein (MGP), which inhibits the deposits of calcium on the walls. Vitamin K, particularly as vitamin K2, is nearly nonexistent in junk food, with little being consumed even in a healthy Western diet. Vitamin K deficiency results in inadequate activation of MGP, which greatly impairs the process of calcium removal and increases the risk of calcification of the blood vessels. An increased intake of vitamin K2 could be a means of lowering calcium-associated health risks.    “  Calcium ConcernsIf at least 32 mcg/d of vitamin K2 is present in the diet, then the risks for blood-vessel calcification and heart problems are significantly lowered, the elasticity of the vessel wall is increased. Moreover, the beneficial effects of vitamins D and K on the elastic properties of the vessel wall in postmenopausal women has been seen in clinical trials. If less vitamin K2 is present in the diet, then cardiovascular problems may arise. Dosing of K2 was supported by a population-based study with 16 000 healthy women aged 49 to 70 years drawn from EPIC’s cohort population. After 8 years ,it showed that a high intake of natural vitamin K2 (ie, not synthetic K2, but not of vitamin K1) was associated with protection against cardiovascular events. For every 10 mcg of dietary vitamin K2 consumed (in the forms of menaquinone 7 (MK-7), menaquinone 8 (MK-8), and menaquinone 9 (MK-9), the risk of coronary heart disease was reduced by 9%. A study on 564 postmenopausal women also revealed that intake of vitamin K2 was associated with decreased coronary calcification, whereas intake of vitamin K1 was not.  ”  A recent, double-blind, randomized clinical trial investigated the effects of supplemental MK-7, MenaQ7 (NattoPharma ASA, Hovik, Norway) for a 3-year period in a group of 244 postmenopausal Dutch women. The researchers found that a daily dose of 180 mcg was enough to improve bone mineral density, bone strength, and cardiovascular health. They also showed that achieving a clinically relevant improvement required at least 2 years of supplementation.It showed a significant improvement in cardiovascular health as measured by ultrasound and pulse-wave velocity, which are recognized as standard measurements for cardiovascular health. In that trial, carotid artery distensibility was significantly improved for a 3-year period as compared with that of a placebo group. Also, pulse-wave velocity showed a statistically significantly decrease after 3 years for the vitamin K2 (MK-7) group, but not for the placebo group, demonstrating an increase in the elasticity and reduction in age-related arterial stiffening.” 

*     Nutrients. 2015 Oct ;7;8905-15.  Menaquinone-7 Supplementation to Reduce Vascular Calcification in Patients with Coronary Artery Disease: Rationale and Study Protocol (VitaK-CAC Trial).Vossen, Kroon ea  Coronary artery calcification (CAC) develops early in the pathogenesis of atherosclerosis and is a strong and independent predictor of cardiovascular disease (CVD). Arterial calcification is caused by an imbalance in calcification regulatory mechanisms. An important inhibitor of calcification is vitamin K-dependent matrix Gla protein (MGP). Both preclinical and clinical studies have shown that inhibition of the vitamin K-cycle by vitamin K antagonists (VKA) results in elevated uncarboxylated MGP (ucMGP) and subsequently in extensive arterial calcification. This led us to hypothesize that vitamin K supplementation may slow down the progression of calcification. To test this, we designed the VitaK-CAC trial which analyses effects of menaquinone-7 (MK-7) supplementation on progression of CAC. The trial is a double-blind, randomized, placebo-controlled trial including patients with coronary artery disease (CAD). Patients with a baseline Agatston CAC-score between 50 and 400 will be randomized to an intervention-group (360 microgram MK-7) or a placebo group. Treatment duration will be 24 months.  We hypothesize that treatment with MK-7 will slow down or arrest the progression of CAC and that this trial may lead to a treatment option for vascular calcification and subsequent CVD.
*            
Ugeskr Laeger. 2015 Aug;177:V12140700. Vitamin K2 influences several diseases]. Hey H1, Brasen CL. Lillebælt, Kabbeltoft, In this paper we discuss the evidence of vitamin K2 deficiency which is a factor in several chronic diseases like diabetes, osteoporosis, cancer, inflammatory and cardiovascular diseases. This deficiency is very common in the mentioned diseases although it is rarely treated by clinicians. Randomized clinical trials have shown that patients witr can benefit from vitamin K2 supplement. Further studies are needed to ascertain the effect of vitamin K2 supplement in patients with diabetes and inflammatory bowel diseases.
*           Oman Med J. 2014;29;172-7. Vitamin k dependent proteins and the role of vitamin k2 in the modulation of vascular calcification: a review.  El Asmar, Arbid  ea, American University of Beirut, Lebanon. Vascular calcification, a cause of cardiovascular morbidity and mortality, is an actively regulated process involving vitamin K dependent proteins (VKDPs) among others. Vitamin K is an essential micronutrient, present in plants and animal fermented products that plays an important role as a cofactor for the post-translational γ-carboxylation of glutamic acid residues in a number of proteins. These VKDPs require carboxylation to become biologically active, and they have been identified as having an active role in vascular cell migration, angiogenesis and vascular calcification. calcification.
*             Dermatoendocrinol. 2015 Jan;6e968490. Vitamin K: an old vitamin in a new perspective.   Gröber U, Reichrath J, Holick MF, Kisters Essen, Germany.&  Boston, MA USA. The topic of “Vitamin K” is currently booming on the health products market. Current research increasingly indicates that the antihaemorrhagic vitamin has a considerable benefit in the prevention and treatment of bone and vascular disease. Vitamin K1 (phylloquinone) is more abundant in foods but less bioactive than the vitamin K2 menaquinones (especially MK-7, menaquinone-7). Vitamin K compounds undergo oxidation-reduction cycling within the endoplasmic reticulum membrane, donating electrons to activate specific proteins via enzymatic gamma-carboxylation of glutamate groups before being enzymatically reduced. Along with coagulation factors (II, VII, IX, X, and prothrombin), protein C and protein S, osteocalcin (OC), matrix Gla protein (MGP), periostin, Gas6, and other vitamin K-dependent (VKD) proteins support calcium homeostasis, inhibit vessel wall calcification, support endothelial integrity, facilitate bone mineralization, are involved in tissue renewal and cell growth control, and have numerous other effects.

26 August 2015 VITAMIN D DEFICIENCY VIRUS EPIDEMIC: HEALTH ADVISORY: MERS,BATS; SARRS , POLIO; EBOLA; CHIKUNGUNYA. OPTIMIZE VITS C AND D3 DOSES. DIARY JOURNAL: DEATH BY VITAMINS/MINERALS DEFICIENCY?: THE EASILY AVOIDABLE FLARE? AND EASY CURE? 2012-2015- MIDDLE-EAST CORONAVIRUS OUTBREAK: its not primarily the virus, but a deficiency syndrome in eg Arabia?.

neil.burman@gmail.com Cape Town, South Africa

CONSPIRACY OF SILENCE, DENIALISM?  THE FLARE AND CURE OF MERS?- MIDDLE-EAST SEVERE ACUTE RESPIRATORY- RENAL SYNDROME SARRS  CORONAVIRUS  OUTBREAK; AND EBOLA?  : An Inconvenient truth?  human (sunshine-) vitamins C+D DEFICIENCY  syndrome facilitating  a benign virus spread from eg  camels  (or mosquitos) to middlemen eg camelmen  to human vit C/D deficient  contacts- in whom the infection becomes lethal ?.   Copyright reserved.  A narrative  diary journal since August 2013

ALWAYS READ IN CONCERT WITH the-semmelweis-reflex-vitamins-c-d3-avoid vitamin-denialism

and  diet-nutritional– vitamin risks-and-benefitS 

and VITAMIN D UPDATE:  https://healthspanlife.wordpress.com/2015/06/16/vitamin-d-for-indoor-types-how-much-is-enough-toxic-especially-for-infants-acute-illness-icu-infections/

and THE CRUCIAL ROLE OF (PRO)HORMONES (MELATONIN, SOLTRIOL-VITAMIN D3 -NOT  VIT D2  – AND VITAMIN C ) AS HRT IN REDUCING ALL MAJOR DISEASE. Salute Dr Walter Stumpf the prophet of the day-night hormone twins  melatonin and soltriol.

What is the greater regional risk, when both Ebola and MERS have at least 40% fatality rate in the susceptible? although the desperately poverty-stricken in west Africa are far more vulnerable to ebola (from bat and common human transmission) than Saudis to MERS (from camel,  and seldom human transmission).
INCREASING RISK FROM GLOBAL VITAMIN D INSUFFICIENCY and THE COMING HAJJ  PILGRIMAGE:

5 September 2015: with the Hajj only a fortnight away, the fresh MERS outbreak in KSA continues its upsurge, with the past week 34 cases  and 11 deaths ie still rising weekly rates. Compared to 16 cases and 7 deaths there in July, August had eight times more– 127 cases;  and 42 deaths ie 33% mortality. Worse, the human outbreak has spread from Riyadh all over the country except on the coast. .

What is even more puzzling is that the KSA now plans to pay out over a $billion ie  $133 300 compensation for  each of the >1200 people who have died there of  MERS . This is despite the fact that, as reported repeatedly on links below, their own scientists keep publicizing that residents there have severe vitamin D deficiency owing to the KSA culturally enforced sun exclusion ie coverup code especially for older adults. And that it costs no more than ~$5 a year for vitamin D3  for each person to take a harmless multidisease protective dose eg adults 50 000 iu every fortnight if not weekly ( as with any microbial after a loading therapeutic dose of eg 200 000  to 500 000iu  if indicated ), with which we get excellent protection  everywhere. Unlike their excellent doctors, KSA authorities dont publish a word of warning and prevention on their English websites  about the deficiency of vits C & D well shown in their urban population.

          26 August 2015 : while the MERS  outbreak in S Korea terminated weeks ago at 184 cases and 29 deaths- ie  16% mortality, with no cases reported anywhere else outside Saudi Arabia in the world, where there were only 129 cases and 32deaths; the latest score from Riyadh KSA is 1171 cases and 502 deaths ie 43 cases and 15 deaths the past week.

Yet a new statement from the KSA MOH this week makes no mention of the apparent chief risk factor for MERS in KSA – their observant  citizens’ profound deficiency of the sunshine vitamin D3  that their sharia sun-excluding apparel  promotes, and that their health professionals have stressed for years, and that is so easily corrected by lifesaving vitamin D3 supplement at negligible cost.  Only prisoners denied any sunshine and supplements have as bad vitamin D deficiency.

25 Aug 2015just a month before the 2015 Hajj, Saudi Arabia has announced  a fresh MERS epidemic this month – based exclusively in Riyadh: in July there were only 16 new cases  with 7deaths  (compared to June‘s 27/14) ie the rate fell to about 4 cases a week. But this August the rate has mushroomed  twelve-fold since July, from 4 to 22/wk,  to now ~48 cases alone the past week @ ~7/day – 72% men;  ie already this month  105 cases, 31 deaths;  ie the recent death-rate has strayed to 29%. .  One of today’s 6 deaths  was among the 8 new  cases   reported today.   Almost all the cases lately have apparently been reported from one Riyadh hospital  the King AbdulAziz center. so the reported totals from KSA  are  now 1165 cases and 498 deaths ie 43% deathrate; with critical cases/ deaths  mostly in the elderly. .

So is   more incidental MERS contamination  being detected by wider surveillance of well contacts? One can speculate whether the recent spurt, and  deathrate, in KSA are because of wider MERS surveillance of asymptomatic people; and the very old dying of usual causes? when  finding of the virus may be coincidental, not pathogenic? Does symptomatic stable indicate anything more than a common febrile URTI? The figures on the KSA Govt website are radically different from those on the FluTrackers.com site.

And VITAMIN D DEFICIENCY THERE?  a new paper in Med Hypotheses. 2015 Aug from KSA again highlights the Saudi scientific community plea not to ignore the disaster of  epidemic and so easily and cheaply remediable vitamin  deficiency there- at least 63% are moderate to severely vitamin D deficientNabi, Hobani ea Jazan University, KSA   ask:  Can we hypothesize a link? High prevalence of vitamin D deficiency and cancer in KSA  populations:      In spite of so much sunshine, about 83.6% of Saudis are deficient in the ‘sunshine vitamin’  D –  31.9% have severe, 32% have moderate and 19.7% have mild vitamin D deficiency (VDD).  Females are more severely vitamin D deficient. Apart from the genetic anti-vitamin D factor- darker skin color – various  manmade factors contributing to skin sunlight deficiency  and thus likely to epidemic viruses (and also  significantly shorter adult life expectancy compared to other opulent countries) include  housing designs, religious practices, lifestyle choices- which in ultra-conservative-run KSA  seem to be uniquely sun-exclusive, and rigorously enforced.

            27 June Update  while the outbreak has leveled off in KSA at 1039 cases with 460 deaths ie 44%,  – only 8 cases but 7  deaths the past fortnight-  the total in S Korea has mushroomed to 182 with 31 deaths ie mortality up to 17%.                                                                                                                                                                                                                                                                                                                                                                                                                                                                         19 June 2015  South Korea reported  ‘its 24th death from the MERS virus and one new case, bringing to 166 the total number of confirmed cases since the first one was diagnosed on May 20′; with mortality  now up to 13% . ‘The number of people in quarantine has fallen 12 percent from the previous day to 5,930. Currently, 112 patients are in hospital for treatment and 30 others have been cured and released.   Thailand became the 27 th country (following S Korea and China)  to be infected with the respiratory virus, took 4 Days To Confirm first MERS Case- a 75-year-old businessman from Oman, Leading To Worries About Deadly Disease’s Spread.         India and Muslim countries gird themselves as risk escalates with Ramadan pilgrimage to the source- KSA Saudi Arabia- now in full swing.

As  especially in Muslim countries, and China, and South Africa, and all darkskinned people who shun the sun- as do all who use sunblockers,  prefer avoiding tanned wrinkled or darker skin or skin cancer- or those who work and live mostly indoors and with covered bodies, limbs and often faces-  Low vitamin D in yet another sunny country- Thailand  ; Jnl Clin  Translat Endocr March 2015 Siwamogsatham ea. Vitamin D deficiency and insufficiency is also common in Thailand ( latitude between 5°30′ N and 20°30′ N) where adequate UVB exposure is available all year round. Chailurkit et al. [12] conducted the largest-scale examination of vitamin D status in Thai population,reported a 50% prevalence rate of vitamin D insufficiency & deficiency , defined as serum 25(OH)D level < 30 ng/mL  .  Life style and environmental factors are the major factors that determine vitamin D status.. Thai women are at risk likely due to sunscreen usage and sun avoidant behavior  to maintain a fair complexion. Living in urban areas  and with less leisure time  in the sunlight., ncreases the risk of vitamin D insufficiency due to increased pollution, which decreases the amount of UVB available for cutaneous vitamin D synthesis.  Furthermore, in Thailand dairy products are not fortified with vitamin D and very few vitamin D-rich foods are part of the Thai diet. Thus, dietary intake of vitamin D in Thai people is generally low.

 

     17June 2015 update: while a German who contracted MERS in the Middle East in February has now died of lung complications in Germany,    KSA Saudi Arabia reported 17 cases and 8 deaths in the past two weeks, similar to the rates in May; totals now 1035 with 458 deaths. Wiki puts the world totals  (26 countries including the Korean who visited China) at 1340 cases with ~530  ie 39%  deaths .

But originating from a single visitor to KSA,  South Korea has now recorded 162MERS cases- 6 cases a day since 20 May-    and 20deaths ie 12%. There a survey- Hong ea in Int J Tuberc Lung Dis 2014  – reported Association between vitamin D deficiency and tuberculosis  in S Korea, with healthy  controls having frank vit D deficiency ( mean 25OHvitD level 16 ng/ml) but 60% higher than in TB patients (mean 9.86ng/ml). The prevalence of severe vitamin D deficiency was higher in patients with TB (51.1%) than in controls ( P = 0.001). The median 25(OH)D level increased from 11.40 ng/ml (IQR 7.85-15.73) to 13.18 ng/ml  after treatment completion (P = 0.037). Presence of TB and history of TB were independently associated with severe vitamin D deficiency.”

Yet as is not available  in local  South African RSA   TB-HIV clinics with prevalent vitamin D deficiency,  there is still no reported policy of vitamin D supplementation apparently reported from S Korea (or KSA, or RSA) , despite (as in KSA and RSA) a study there 2 years ago  (from Jeong of Dept Paediatrics at CHA University, Seongnam SKorea 2013)  “Factors affecting the vitamin D status in South Korean children”  finding  ” prevalence of vitamin D deficiency (
(15-20 ng/mL) was 19.5%. Overall, the mean serum 25(OH)D levels was 22.9±9.9 ng/mL. They were the highest in them preschoolers (2-5 years, 24.4 ng/mL) and the lowest in the adolescents (11-16 years,15.9 ng/mL). In addition, they were significantly higher in summer as compared with winter. The prevalence of vitamin D insufficiency and deficiency was relatively higher in our series of children. It is imperative that the public policies be established to provide vitamin D supplementation for South Korean children.” 

 ONGOING GLOBAL DENIAL OF NEED FOR MICRONUTRIENT SUPPLEMENTS:   It seems that national authorities from the Americas  to Europe to Africa to the middle east to Asia,  including the medical industry,  continue to refuse to heed overwhelming evidence that vigorous micronutrient supplements are needed, available, lowcost, highly effective and safe  to prevent and treat epidemics like HIV-TB, flu, MERS and Ebola – especially when vaccines and antiviral drugs are without benefit, and when vitamin D deficiency is universal in clothed indoor-studying- and -working  peoples, especially the poor who cannot buy supplements by choice. . .

            6 June 2015 update: After a quiet April, KSA is now suffering  fresh jeopardy from  acute  midsummer flareup of MERS. But so is  the world with outbreak  of MERS in Korea and China, while thousands of refugees from tribal wars in  the middle east and North and even South  Africa cause more concern for spread of such plagues.

As the Middle East  girds itself against mounting Islamic warfare in the region, after only a handful of MERS cases in April- 8 cases and 6 deaths- KSA has in May  seen 33 cases with  >50% fatality – 18 deaths; and already in June the case rate has doubled from April’s  1 a day  to May – June’s 2 cases a day, giving cumulative totals there  to 6 June of 1026 MERS cases and 450 deaths..

By contrast, in   South Korea   only  5 deaths (8% mortality) have been reported in 84 cases so far the past 16 days – including a Korean who got to China. That chillingly brings the outbreak firmly onto the Asian mainland.  South Korea now passes the UAE as the second biggest outbreak country after the KSA- but like the UAE and elsewhere, a far lower deathrate, perhaps simply because of initial contact tracking, since the outbreak has been totally in hospitals.

It seems that  Vitamin D deficiency may be as much the cause of MERS susceptibility in South Korea as in KSA?  A 2008 Korean University survey shows that despite its temperate latitude of  ~35degrees, and humidity, South Korea had widespread vitamin D deficiency even in its young people: Serum 25-hydroxyvitamin D [25(OH)D] levels and the prevalence of vitamin D insufficiency defined as serum 25(OH)D level of less than 20 ng/ml. Vitamin D insufficiency was found in 47.3% of males and 64.5% of females, whereas only 13.2% of male and 6.7% of female population had a serum 25(OH)D level of greater than 30 ng/ml. Vitamin D insufficiency was most prevalent in the age of 20-29, with a rate of 65.0% in males and 79.9% in females, and least prevalent in the age of 60-69 in males and 50-59 in females. Those who work usually indoors were more predisposed to vitamin D insufficiency. In the adult population, predictors for vitamin D insufficiency included young age groups, spring and winter seasons, living in an urban area, and indoor occupations.  CONCLUSIONS:Vitamin D insufficiency is very common, and it is now a greater threat to the younger generation in Korea. Current recommendations for vitamin D intakes for Koreans are inadequate, especially for the youth. In 2012 they reported “We found that vitamin D insufficiency or deficiency is a very common health problem in Korean adolescents, particularly in girls, and that serum 25(OH)D levels are inversely associated with insulin resistance and lipid profiles. These results suggest that more time spent in outdoor activity for sunlight exposure and higher vitamin D intake may be needed in younger adolescents in South Korea”

In a recent university study by  Han Seok Choi  on vit D deficiency in S Korea- perhaps the worst measured vit D deficient country  in the world? – he refers to  Autier ea in Lyon France in JCEM 2012 – “The average increase in (in adult) serum25(OH)D   was 0.78 ng/ml per microgram of vitamin D3  supplement (40IU ) per day”. ie the average ~20ng/ml vit D level in so many deficient adults  will increase by only ~8ng/ml for every 400iu vit D in an average daily “RDA” multi-supplement; to raise their level to a more efficient 60ng/ml requires at least ~2000iu/day or 60 000iu per month; and if diseased, to raise to a more vigorous 90ng/ml requires at least ~3000iu/d . But as others have reported, higher dose oral vitamin D3 gives a less vigorous response eg 10ng/ml rise per 1000iu/day; eg  my 25OHvit D level is about 90ng/ml on about 9000iu vit D3 supplement a day (half-life estimated 2 weeks to 2 months  in Modulation of the Immune Response to Respiratory Viruses by Vitamin D) and plenty of fat eg an average egg, cheese and doublecream yoghurt etc  daily ; with no rise in my corrected serum calcium, and no visible calcification on my xray chest or echocardiogram  . .Autier ea wrote “76 trials published from 1984 to  2011 included 6207 subjects  tested supplement doses ranging from 5 to 250 μg/d  ie 200 to 10 000iu/d(median, 20 μg/d).  In the absence of concomitant use of calcium supplements,  average increase in serum 25-hydroxyvitamin D concentrations was 0.78 ng/ml (1.95 nmol/liter) per microgram ie 40iu of vitamin D3 supplement per day. Compared to the vitamin D3, the vitamin D2 was associated with significantly lower increases (P = 0.03). Concomitant use of calcium supplementation and high 25-hydroxyvitamin D concentration at baseline was nonsignificantly associated with lower increases in 25-hydroxyvitamin D concentrations.

         “Vitamin D Deficiency Around the World   2015   Even the Indian Medical Association recently organized continuing medical education to address the rise of vitamin D deficiency in their sun-soaked nation. Endocrinologist Dr. Sanjay Badada told Times of India:1   Vitamin D deficiency is rapidly gaining epidemic proportions yet it is the most under-diagnosed and under-treated nutritional deficiency in the world.         In our experience, 40 percent to 50 percent patients get diagnosed with Vitamin D deficiency as a part of their normal routine tests with no apparent symptoms.    On the other hand, 80 percent to 90 percent of patients who come in with musculoskeletal complaints such as back pains, unexplained muscle pains, or general fatigue suffer from Vitamin D deficiency.     Vitamin D was also discussed at the 2015 European Congress of Endocrinology. One talk2 addressed the “Mediterranean paradox,” as researchers have tried to understand why as many as 90 percent of pregnant mothers (and their newborns) in the sunny Mediterranean region are deficient in vitamin D.      A systematic review looking at 15 studies concluded that predictors of low maternal vitamin D concentration included dark skin and sartorial habits—meaning the manner in which they dress, or in this case, being too covered up, preventing sun exposure on bare skin.     Moreover, vitamin D supplementation was very low, and few pregnant women met the recommended daily intake (RDI) of calcium and vitamin D.”

12 April 2015 update: KSA has now reported 977 cases with 426 deaths ie 43% deathrate. Ignoring the past 12 days (2 cases, 4 deaths),  the March rate was 1.9 cases per day with  49% deathrate; in Feb it was 3/day with only 42% deathrate. so while the reported caserate is down by a third, the fatality ie deathrate is up almost 20%. The Wiki  MERS report is now a month  out of date, with climbing deathrate.

Perhaps the lull in new MERS case detection/reporting  is merely a result of that region (like the war-torn Central Africa – never mind the ebola epidemic-)  being in the middle of an ethnic Muslim religious  war – genocide-  by fanatical  jihadists on both more “liberal” Islamists and other religions. This  increasingly threatens to overthrow the 20thC-European-created hereditary tribal governments of the desert/camel/oilfield region- KSA, Yemen,   Jordan, the Gulf States etc, as happened in Egypt; not to speak of the power vacuum instability  created in Iraq and Libya by more recent Western elimination of virtual dictators  without ability to ensure democratic succession there any more than in Egypt, Afghanistan or Pakistan; and the oppressive dictatorships that prevail  in Iran and Syria..

24 March 2015    KSA reports 964 cases   and    419 deaths ie  only 6cases and 3 deaths the past week. The Ebola outbreak meanwhile simmers down in W Africa in its anniversary week. . New reports from North America again highlight the importance of optimizing vigorous vitamin D3 dose and blood levels.

15 March 2015  MERS   so far this March, in KSA already  37 cases  , ie 17 a week,   21 deaths.  This brings the reported case  KSA total to 957 cases, 416 deaths; but deathrate the past 4 weeks to ~57% (the KSA website) . With the timelag in KSA reporting to international registries, Wiki reports that to 12 Mar there were  only 402deaths /938 cases in KSA ie 43% deaths; but 1082 cases worldwide with 439 ie 37% deathrate in 24 countries-  118  cases with 28 deaths  in the 8 middle east nations surrounding the KSA, giving a deathrate around but not in KSA of only 24%, and 3 deaths in 7 cases in their 3 African neighbouring countries;  and 8 deaths in 22 cases in 12 distant countries ie 36% deathrate.

so while there have apparently been no new MERS cases outside KSA in their summer for months, the ongoing reported caserate in KSA is alarming with the deathrate having climbed to 55%. Obviously, to explain the apparent rising deathrate,  detection and reporting of new MERS cases in KSA will likely be increasingly of only serious respiratory cases and their immediate contacts; and otherwise unexplained deaths; but the fact is that 10 MERS- associated deaths were  again detected there   the past week..

So while camels rather than bats are teeming with MERS virus and believed to be the main vactor to their human compatriots, it is instructive to to see a number of recent studies  (1, 2, 3) in north African camels showing that they have vitamin D levels 10 to 40 times higher than Arabian citizens who import them en masse, farm, nuture, milk  and eat them. MERS is if at all a trivial coronavirus corrhyza in such camels, like the common cold coronaviruses cause  in humans. This contrasts with the scarcity of MERS cases reported from N Africa- where camel farmers presumably do not cover up as religious law makes the Saudi citizens do.

And it  correlates with the epidemic of Ebola in central West Africa- Guinea, Sierra Leone and Liberia  , where the chief vector of Ebola seems to be ebola-resistant fruit bats, who live in the dark and have very low vitamin D levels- presumably like their very dark-skinned human compatriots, who presumably also still live largely in the forests or in cities and thus have equally low vitamin D levels; and thus far reported about 25000  suspected cases and 10000 deaths ie 40%; with no antiviral cure in sight; with ?4 deaths in ?18 cases so far reported outside  Africa.

These are more reasons to pour safe lowcost effective antivirals vits C and D3 (with balancing vits A,   Zinc etc) into such patients and their compatriots at risk. (vit K2 supplement matters only long term against arterial calcification, osteoporosis and cancer in longevity.)

7 March 2015.   EPIDEMIC BY power-crazy RELIGIOUS  & ECONOMIC EDICT?: MERS:  globally  ~1040 cases of MERS have been reported. But apparently none outside Saudi Arabia in recent  months: So March  opens in KSA  with 7 day MERS caseload  19  new cases (mean age ~56yrs), and 8  deaths ie total now 939 and deaths 403. . Thats ~20 cases reported the past 7 days there, with 10  deaths ie 50%… in a country in which  18 months  and more ago endemic vitamin D deficiency was reported in the Saudi Gazette by their scientistswidely attributed to the obvious cause, that in a land of such abundant sunshine, more so than in any other country in the world, women  are obliged by draconian religious law   to cover up almost totally outside their houses,   and  elderly observant men almost as much.

European Journal of Clinical Nutrition , (18 February 2015) Determinants of vitamin D deficiency among undergraduate medical students in Saudi Arabian BinSaeed, Al-Drees ea        A cross-sectional study was performed among 255 first- to fifth-year male undergraduate medical students of a major universities in Saudi Arabia.  Results:   Majority of Saudi medical students (75.2%) had 25(OH)D levels <30nmol/l = <12ng/ml,. Multivariate analysis showed that the odds of having 25(OH)D serum levels of greater than or equal to30nmol/l were seven times higher both in students who took vitamin D (odds ratio (OR)=7.2, 95% confidence interval (CI)=1.8–29.9, P=0.006) or multivitamin supplements (OR=6.9, 95% CI=1.7–27.3, P=0.006) within 1 year..   There was no significant association between 25(OH)D serum levels and average time spent outdoors per day (P=0.369) and type of clothing (long-sleeved vs short-sleeved; P=0.800).     Conclusions:   Vitamin D deficiency was highly prevalent in Saudi medical students. Modifiable factors such as vitamin D intake and PA could be targeted for intervention.

Wiki says (and Medscape echoes) that “Immune system: “While it is known that melatonin interacts with the immune system,[53][54] the details of those interactions are unclear. Antiinflammatory effect seems to be the most relevant and most documented in the literature.[55] There have been few trials designed to judge the effectiveness of melatonin in disease treatment. Most existing data are based on small, incomplete clinical trials. Any positive immunological effect is thought to be the result of melatonin acting on high-affinity receptors (MT1 and MT2) expressed in immunocompetent cells. In preclinical studies, melatonin may enhance cytokine production,[56] and by doing this counteract acquired immunodeficiences. Some studies also suggest that melatonin might be useful fighting infectious disease[57] including viral  and bacterial infections, and potentially in the treatment of cancer.”

on Pubmed melatonin as an immunomodulator goes back to 1980.

As Wiebke Arlt and Hewison wrote in 2004, “Aging is associated with a decline in immunity described as immunosenescence; paralleled by a decline in the production of several hormones, as typically illustrated by the menopausal loss of ovarian oestrogen production. However, other hormonal changes that occur with aging and that potentially impact on immune function include the release of the pineal gland hormone melatonin and pituitary growth hormone, adrenal production of dehydroepiandrosterone and tissue-specific availability of active vitamin D. It remains to be established whether hormonal changes with aging actually contribute to immunosenescence and this area is at the interface of fact and fiction, clearly inviting systematic research efforts. “

But Observant- aging-  Muslims are forbidden  the prime cicardian rhythm of outdoor sunshine stimulation of their skin,  and in women   even their retinae with total veiling. Thus although women are the tougher gender, observant  Islam condemns them to be increasingly   more compromised goods and chattels than even camels…

There is still no word that the KSA has recently bothered to promote vigorous dose vitamins D3 and C, ( with vit A, zinc, selenium and iodine), as simple safe potential antidotes to their heavily enforced overdressing blockading sunshine-vitamin D3 , that their own medical scientists have repeatedly warned about..

A new report saysEbola virus is among the most deadly pathogens, with case fatality rates of up to 90%.1 Ebola virus is categorized as a tier 1 pathogen by the US government because of its potential for deliberate misuse with significant potential for mass casualties. The current outbreak of Ebola virus in West Africa with more than 23 000 cases and 9000 deaths2 also demonstrates the long-underestimated public health threat that Ebola virus poses as a natural human pathogen. There are no licensed vaccines or postexposure treatments for combating Ebola virus.

But as with pollution, insecticides, road carnage, influenza, TB,  HIV-AIDS, malaria, cholera,  smoking, sugar, aspartame, alcoholism, it doesnt suit the Big Pharma  & Disease Corporates, their paid marketing professors/researchers at universities, and  government and hospital/ health industry, to promote avoidance, prevention, cure,  natural cheap available remedies like vitamins, minerals and other natural remedies, when disease requiring hospital admission, a patented synthetic vaccine or other drug is far more profitable. . Only Disease Pays.

28 Feb 2015   after a quiet KSA  2014/15 year-end with declining   MERS case reports- 11 in December,  20 in January, the past week has seen  18  new cases but 9 deaths in  KSA, the KSA totals SINCE 2012 UP  to  920 CASES AND 395 DEATHS (43%) ie  for  February  75cases and 31 deaths. . As always, until the KSA MOH Command clarifies, how many of these are current, versus catchup reports from previous weeks/months, remains to be seen. But as the winter recedes there, the death rate this month remains 41%%…. 

And in UAE  one new (expat) case died this month; and a new case in a nurse returning to the Philippines from KSA is the first case in that country, .. combining KSA with Wiki stats, bringing apparent world totals to perhaps about 1029 cases and 420 deaths.. The deathrate from MERS has widened starkly from 42% in to  30% outside   KSA.

8 Dec  2014:       HEALTH ADVISORY FOR VISITORS TO OR FROM MIDDLE & FAR EAST,  EUROPE,  AFRICA, the AMERICAS:  The MERS infection outbreak slacks off:  – down from the recent 2 cases a day to 25 cases in November with 12 deaths; 4 cases so far this month with 3 deaths- ie the deathrate is picking up.  .  No more exports reported from KSA since one  returned home to Qatar last month. the quadrupled case rate  since October has fallen back from 39 cases & 15 deaths a month  ; – and deathrate (9 deaths) in October in KSA  that  doubled to 0.6/day is back to the 55% rate,  still awesome for such a rich and sophisticated country.

though MERS is well below that of the ebola epidemic – some 5000 ie almost 40% deaths  among  15000 cases  so far-  that is ravishing central  west Africans impoverished by genocidal warlords; not to mention flu, cholera, HIV, TB, polio-and dengue-like illnesses . Two  ebola- infected people from  W Africa have died in USA, but 8 have recovered in USA from Ebola .

Latest evidence is that the current ebola epidemic is due to bats-   human overpopulation causing massive deforestation, displacing ecologically vital  bats (never mind vital bees,  birds and butterflies)  from their natural habitat.   Liberian workers  who flew to USA  and Germany  with Ebola died; but 8 of 9 infected cases have recovered there; as have infected European health workers. .. . .    

  But West Africans are reportedly trying to flee to South Africa to escape the epidemic. and 9 out of 16 Medicine sans Frontiers staff who contracted ebola died. .Is ebola falling there? or are patients simply hiding, dying outside hospitals?

SO  OPTIMIZE YOUR DIET, VITAMINS D3   &  C DOSES, SUNSHINE, AND  AVOID  SELFSABOTAGE- SMOKING, SUGARS, ALCOHOLISM, AND RASH HYGIENE.

25 Nov 2014 the MERS toll mounts in KSA- the past week only 4 new cases but 5 deaths. so this month its 21 cases, 11 deaths.

20 Nov 2014 Now 808 cases ie 18 this month, only 5 the past running week; with 9 deaths this month; so 12 cases under management.

13 November 2014   The rates pick up again- KSA declares 16 cases under treatment, 447cases recovered,  804 cases, 342 deaths; ie this month 15 cases and 5 deaths  .

4 November 2014:  KSA declares 15 Cases Under Treatment, 440 Cases Recovered,  793 Cases,  338 deaths, ie in the past week 13 new (9 Saudis, 4 expats)  and 5 deceased cases of MERS.

22 Oct 2014:  now the KSA declares  12 Cases Under Treatment, 431 Cases Recovered, 772 Cases, 329 deaths; ie 9 more cases in KSA past week  ie  1.3/day. So thats 18 cases in 22days ie the case rate up to >0.8/day, with 10 deaths  – all with previous chronic illhealth –  this month ie mortality lately 55% (8 Saudi males age 51-69, a Saudi woman age 55 and an expat male age 40)….

14  Oct 2014  The first MERS case outside KSA was reported yesterday in Qatar, in a returnee from KSA, ie thats 5 cases this week contracted in KSA, reportedly bringing world total to 892 cases and 356 deaths.  Croft  says Over the past 30 days Saudi Arabia has reported 17 MERS infections, 9 of which were from the Taif region; which concurs with the KSA stats excluding the backlog of old cases reported last month…  Four  Saudi males this week  with MERS in Jubail, Taif and now Riyadh , and  deaths each in Riyadh and Taif..  so Saudi MERS  cases there  now 10 Cases Under Treatment, 429 Cases Recovered, 763 Total; and 324 deaths ie 43% death rate . In 14 days this month that’s 9 new cases in KSA, 5 deaths, 3 cases recovered; compared to September’s  net   ?12  new cases. The stats for September (incl  19  deaths)  are blurred by the adjustments announced on 19 Sept (with previously unreported cases up to 3 June, with net 16 new cases after other corrections); so the new cases and deaths reported in August may be correct-4 new pts,  4 deaths; and July 9 new  cases, 6 deaths; and June 28  new cases? .. .

So the MERS  case rate in KSA so far this  month has mushroomed from the  0.3/day  in July, the  nadir of 0.13/d in August, ? 0.4  in Sept,  to 0.64/d this month; and the deathrate from 0.2/d  in July to the nadir of 0.13/d in Aug to >0.6/d this month.

BUT 6/9 OF THE NEW CASES THIS MONTH HAVE BEEN IN THE GARDEN RESORT CITY OF TAIF 100 KM SOUTH OF MAKKAH- mostly in Saudi men with camel contact.  perhaps this may be because of a resevoire of MERS in camels there. The climate may be favourable for humans BUT ALSO FOR MERS- October temps of 15 to 30c, humidity of 40%, 11 mm rainfall.’

     MORE ON OPTIMAL VITAMIN D3  DOSE, AND THE DIFFICULTY OF ACHIEVING CLINICAL  OVERDOSE:      Four  new reports highlight  how  difficult, and important  it is to achieve adequate optimal bloodlevels of vitamin D with vigorous vitamin D3 supplements, let alone overdose with any significant adversity: note three   used the  recommended vitamin D3,   not the long-condemned mislabeled Lennons/Aspen vitamin D2 (which is misleadingly labelled  “caciferol” without disclosing that it is D2 not D3). Even a single  2 million iu overdose of vit D3 in nonagenarians had no adverse effect-since the bloodlevel was back to zero by 3 weeks, thats above 100 000iu/day on average…....continue..

            8 Oct 2014  1st Ebola case diagnosed in Dallas USA in  a Liberian visitor, who died today (one of > 4000 deaths  in W Africa estimated so far); and a new case in Spain, the first infection outside Africa. Ebola anxiety spreads..                                                                                                                                                  It is alarming that the MERS deathrate is not falling but rising  there-5  new MERS  cases already this month,  vs 12 in Sept,  5 cases  in August; and  now 8 deaths  in past 38 days..

VITAMIN D3 DOSE: We get excellent results in outpatient adults with loading oral dose of  vit D3 of about 200 000 to 400 000iu depending on illness severity and body mass; then pro rata about 50 000iu  per week till better, tapering to fortnightly when well; pro rata in kids...continue..

​​​​​​30 Sept 2014 another new Mers case in KSA, a 70yr old Saudi man in AlMadinah. 

AND   From: David Ponsonby  September 29, 2014   http://healthimpactnews.com/2014/flu-vaccine-is-the-most-dangerous-vaccine-in-the-united-states-based-on-settled-cases-for-injuries/ 

       “The last report issued  December 2013 for the previous 3 months  by the USA Department of Justice (Vaccine Court), for compensation made by the USA Services for people injured or killed by vaccines – available as a Power Point presentation –   139 claims settled , with 70 of them being compensated. So, just over 50% of the claims filed for vaccine damages were compensated during this period.     Once again, the greatest percentage of damages compensated were for the influenza vaccine, and most of those were for Guillain-Barré Syndrome (GBS).           Yet these facts, in a Department of Health website, are never reported in the mainstream media. Read the report yourself in the Power Point file here.   Of the 70 cases compensated, 42 ie 60% were for the flu vaccine. The combined total of the other 40% of cases settled included the following vaccines: Hep B, Tetanus, HPV, DTaP, MMR, IPV, PCV, Hib, Meningococcal, Varicella, TD.

29 Sept 2014  MAJOR  SAUDI  UPDATE:   FRESH MERS FLAREUP WORSENS:  There have lately been 3 new cases, (2 Saudis and an expat), near Mecca; 2 in Riyadh- and now   death of  a  38yr old previously well  Saudi woman in Riyadh.

Thats  3 MERS deaths; and 4 new cases – Saudis- in central KSA  the past  10days, 11 this month; contradicting  the puzzlingly optimistic comment this week from KSA  health ministry’s Fakeih that  “MERS is not an issue in Saudi anymore. We are  doing all we can to have a safe Hajj for all our guests.”  If MERS is not an issue, why is the new caserate  there picking up, and the deathrate not falling?

the KSA Ministry‘s recent audit found  some 19 previously unlisted MERS cases in the 10 week April -May 2014 surge – all but three of the cases were in Jeddah- plus some false positives , and  changes of status..

The totals there now are 8 Cases Under Treatment, 426 Cases Recovered,753 Total; and 319 deaths ie 42% death rate .

But outside KSA there have been no further MERS cases or deaths reported for months, so thats apparently worldwide 885 cases , deaths 353 = 40%. But the deathrate outside KSA remains only 26%. and outside Arabia the deathrate remains 10/30 ie 33%.
     Despite the surge in KSA in the ~10 weeks mid-March till early June, before  the peak summer season in the Northern Hemisphere,   the ongoing outbreak in KSA (14 cases there since the month’s lull till mid-August)  contrasts with the last MERS cases reported outside KSA  in early-mid-July   about 10 weeks ago 2 cases in Abu Dhabi ie the UAE,  & 5  in Iran. .

So thats a total in KSA of 20 more new cases  and 13 more deaths  than was reported before the audit on 12 Sept.  Of the  KSA 749 total,   27% were  healthcare workers; 65% were Saudis-  the vast majority this season in Jeddah and Riyadh;  ​​​​61% male; 4% under 16yrs, 45% between 16-45, 27% 45-60. and 24% 60+ years. ie approx  15% of all cases in  every 15year age bracket from 16yrs up, but only 4% in the first 15 years. Deathrate was “only” ~18% in  EACH OF the three  15year agebrackets up to 45 years, but 45% in the 46-60yr olds; and quadrupled to 80% over age 60years.Thus unlike eg flu, only in the KSA elderly is  MERS par excellence a highly risky infection    .

MERS IN KIDS:   the likely number in KSA extrapolated from 4% of 749 cases is about 30  kids under 16yrs;  but the new KSA  bargraphs show ~18% deaths in kids ie about 5-6 died. so the child deathrate has doubled from  9% 1/11.    In Dr Memish’s April paper there were only    11 pediatric cases  positive by screening and confirmatory PCR for MERS-CoV reported from Saudi Arabia. Two patients were symptomatic and the other 9 cases were asymptomatic. The median age of patients was 13 (range 2-16) years. There were eight females and three males (2.7:1 ratio). One symptomatic patient died  (1/11 = 9%) and the other symptomatic patient recovered. The diagnosis of patients was based on positive nasopharyngeal swabs on the majority of the patients.  Most cases of childhood MERS-CoV infection was asymptomatic and tested positive during contact investigation of older patients. Severe disease can occur in children with underlying conditions.

So in KSA  with a mean population age close to 20 years, the age distribution of MERS is roughly spread across adult lifespan, sparing  (with both low incidence and low mortality) children who make up almost half the population. This is the opposite of the claimed swine flu severity in kids in the “pandemic” of 2009.  Perhaps in KSA this is as expected since generally schoolchildren take more dairy products, get more exercise, sunlight, fresh produce  and supplements, and wear less sun-exclusive clothing- supporting  vit D+C deficiency evidence as the proximate  cause of MERS-CoV susceptibility in KSA adults..

So despite repeated published warning from the top KSA scientists that their conservative (ie covered) dress and diet  code puts Saudis at very high risk of known vitamins C & D & Zinc deficiency, the blackout on acknowledging this and promoting vigorous vits C and D3 & Zinc supplements continues, with 80% death risk for the elderly and 20% for every  child who contracts MERS in KSA. Until proved otherwise by simple trial of vigorous supplements, this  denial, omission    in fact may be culpable homicide on the part of KSA authorities- especially as the KSA, with a mean annual income per head similar to UK and western Europe and with similar Caucasian origin population, notoriously has life expectancy 5 years lower than that of UK and much of the North Atlantic  lands. .

16 Sept 2014  one new case today 31yr old expat male, prev chronic, in ICU Riyadh; yesterday  76yr Saudi male  in the far south, prev chronic, in ICU. total thus 730, 29 active,…  already 5 in 2wks this month.. as the Hajj picks up…

12 Sept 2014 Bad news strikes KSA with the Hajj in full swing- after 3 clear days, 2 new MERS cases but not in the eastern provinces like the last cluster, this time one each in Riyadh and the Mekkah region, both Saudis, both in ICU;  but not the usual seniors- a 38yr old male with previous health issues;  and 28yr old female, neither of them healthcare workers.                                                                    So now the KSA numbers are 28 under care;  399 recovered; 729 total; 302 died.

8 SEPT 2014 after 9 case-free days, the 727th  new case, 60y old male expat, in Jubail, in ICU…

31 August 2014 THE KSA MERS CASE RATE PICKS UP: 42% death- rate: another new case 29 Aug, a 34 yr old expat health worker in Jubail, ie 3 cases in past 7 days. another MERS-related death- a 69yr old Saudi man in Dammam- as usual, with preexisting disease. .  So KSA has  now  25 Cases Under Treatment;    399 Cases Recovered ; 302 cases died;  total  726 Cases ie 42% died.  45% dead or impaired.    5 new cases past month.  and apparently 4 deaths. KSA reporting does not allow analysis of duration of illness to assess the current mortality rate.

Yet  Drosten, Memish ea from the international  Corona Virus Study Group write in the NEJM this week:  “Transmission of MERS-coronavirus in household contacts is only 5% in 26 MERS index patients and their 280 household contacts. Strategies to contain the MERS-CoV depend on knowledge of the rate of human-to-human transmission, including subclinical infections.   The median time from the onset of symptoms in index patients to the latest blood sampling in contacts was 17.5 days (range, 5 to 216; mean 34.4d“.

This again confirms  the obvious, that the virus, like the common cold, is low virulence and transmissibility EXCEPT in the frail  and elderly – who (perhaps like many overworked hospital workers)  in KSA who as reported there  apparently get little sunshine, little vitamin D3, and likely little vitamin C. The rate of MERS in students, kids, farm workers, labourers  remains very low, presumably because they get plenty of sunshine. And no article/report on MERS from KSA – where all adults are forced to cover up their skin outdoors- says that anyone is encouraged to vigorously top up their vits C and D3 levels.
​​​

OUTCOMES: triangulating cases  scantily reported on the KSA MERS website   with 30 new cases since mid-June,  5F (28-55yrs, 4 Saudis)  and 25 men; there have been 8 deaths all in men between 38 and 80yrs old. The high deathrate in the men may be because their average age was about 59yr vs 41yr in the women.

August:   5 new cases  (1 Saudi  female; 1 male  an expat HCW; 2 of the men- 69 and 72yrs, Saudis, chronics,   died within 3 and 6 days respectively ),

July:  10  cases;  2 Saudi female; of the 8 men, 2 are HCW , 2  expats- one of whom died the same day aet 73yrs.

June: 24 cases.  Reporting was upgraded 1 June, so stats before July- with the ~100 case undated backlog reported- are problematic. from mid June there were 15 cases reported, 3 females; 5 deaths (2 expats aet 38 & 42)  in the 12 men; the Saudi deaths were aet 45-80yrs.

27 August 2014  2 new cases past 3 days, Saudi man and woman in Dammam.(one subsequently proven false +ve)   25 Cases Under Treatment, 399 Cases Recovered ;   725 Cases   Total;   301 cases passed away .
​​​​​​​​​

 24 August 2014: 12 days free of new MERS cases in KSA.      but on 22 Aug the death of another male, a 66yr old expat, was reported in Riyadh,  this  totals  23 Cases Under Treatment, 399 Cases Recovered; 301 cases passed away, (May Allah have mercy upon them). * Total  723 Cases.  44.8% dead or impaired.

​​​​But Alghamdi ea from the KSA Govt &  Universities, and Lincoln University UK have this week  published  The pattern of Middle East respiratory syndrome coronavirus in Saudi Arabia: from June 2013-May 2014  ie some 425 cases (before the recent June “discovery” of another 100+ cases there). This study deduces that the outbreak thrived especially in Riyadh and Jeddah  with high temperature and low humidity ie summer desert conditions;   older men being at much higher risk than their kinswomen. . But once again, the paper  studiously avoids the obvious reasons why KSA is at the hub of the MERS storm. The authors   like the KSA authorities totally ignore the repeatedly published studies by their own academics the past decade, and even by USA authorities like Prof Mike Holick, that Saudis have markedly low vitamin C and D and even zinc levels. And their increasingly orthodox overdress as they age and have more leisure time drastically increases their vitamin D deficiency.

This comes back to usual Media and Governmental  Semmelweis denialism , persisting  with the myth that good diet  and prescription medicines are  enough.  In fact balanced nutrition with fresh natural produce is becoming a rarity even in stable progressive urban cities, and  the resultant epidemics of infections let alone degenerative diseases are in most cases due, (apart from deliberate pollution especially with plastics, estrogenics , pesticides, endocrine disruptors eg phthalates,  heavy metals including fluorides, bromates;   dioxin etc,  radioactivity,  and high refined carbs,  and inadequate fish oil and medium chain triglycerides  and water intake),  to micronutrient deficiencies especially of vitamins C, D3, K2,  and crucial minerals like magnesium, zinc, iodine, selenium, chromium  etc.

Modern infectious outbreaks like the resurgence of influenza, polio, TB, HIV  and MERS, and hemorrhagic fevers like Ebola and Marburg, are arguably as others have proposed deficency diseases – eg scurvy, since all the severe infections listed, never mind acute bacterial infections, have been shown for almost a century to respond dramatically to highdose vit C, vit D3 and some zinc, and multivite (A,B), without antibiotics or much benefit from eg ARVs or tuberculostatics. .

     As of 12 pm  August 20, 2014:  “now only 25 Cases Under Treatment; 398 Cases Recovered Total  723 Cases;  300 cases passed away”

​​​​    19 August 2014 : KSA  updated figures  no new MERS cases past  7 days.  BUT  another death– a 72yr old Saudi man  with previous chronic disease,  in Riyadh on 17 Aug. so  “As of 12 pm  Aug 19, 2014:  723 Cases,  26 Cases Under Treatment; 397 Cases Recovered; 300 cases passed away   (May Allah have mercy upon them).”. ie the death + impaired rate  326/723 has risen to 46.4%, deathrate 41.6%. ?? 855 cases, 334 deaths  worldwide?

So thats 326 patients in KSA who died or are still impaired by MERS, who might have been spared by simple highdose vits (D3 +  C) supplement-at trivial cost,  no major adverse effects, but massive evidence of protection and cure against all serious diseases; in a population at long-known high vits C+D3 deficiency risks. .

The Zeitgeist occupation analysis of MERS cases to 4 June shows unchanged pattern: 164 Health workers,    150 retired persons,  23 children,  11 pilgrims, 3 tourists,  2 construction labourers, 1 butcher, 1 camelbreeder, 1 shepherd… (out of 838 cases reported till then- ie occupation was disclosed in only 44% ie 380 pts) . The reason for the majority nondisclosure is not given.

The question remains: why are (inter)national authorities ignoring all the published evidence linked below, that vigorous dose vitamin D3 supplement eg 5000iu/kg  loading dose then 1500iu/kg/fortnight eg 100 000iu every two weeks , plus a few grams of buffered vitamin C a day, drastically reduces all diseases including virus infections?

12 August 2012 KSA  reports (after a month free of new cases)  despite peak summer there, two new  previously chronically ill   Saudi cases  in two days:  a 72year Riyadh man; a 59 year old  man far south of Riyadh; and death of a previously reported apparently formerly  well 74 year Riyadh Saudi man. But they dont say when these recent elderly Saudis took ill or died.  Total in KSA now 723 cases, 41% deaths. 28 cases under treatment  ie 45.2% dead or impaired. ..

To put MERS in perspective, Ebola in Central Africa this year has  infected  over 2000 cases, 50% deaths, probably worsening the >100 000 malaria deathrate per year in the region, globally >200 million cases a year with a million ie 0.5% deaths.. ..  Mosquito-spread Chikungunya virus spreads from Africa/Asia   to over 570 000 people  across  the central Americas .. …   .

9 Aug 2014  still not over:  NOT THE END OF THE ARABIAN MERS CoV OUT- BREAK-  STILL MORE QUESTIONS THAN ANSWERS, :  its now  30 days since the last reported MERS case –  BUT  the  fact  is that the KSA Bulletin chillingly reports  “As of 12 pm  9  Aug, 2014:    1.” still 27 Cases Under Treatment     2. 396 Cases Recovered.  3. 298 cases passed away (May Allah have mercy upon them).  total 721 case.   so 30 days after the last recorded new case,   27 patients there are still suffering from MERS sequelae – for at least four weeks duration now, likely now permanent?. .

27 cases out of 721 total reported in KSA is only about 4%. But since these 27 cases remain under care a month  after the last reported new case, they must now  be at best approaching chronically impaired, if not on renal  or respiratory assistance.  ie the total of dead and impaired rises to 325/721 = about 45%. More important, KSA has apparently not yet released an analysis of the demography and primary and secondary causes of death of these cases- presumably by MERS definition, respiratory and renal . This analysis is urgently needed. All we know for certain is that there was a MERS outbreak apparently in one of their Dialysis units; and that the outbreak was especially bad in health workers especially hospital staff.

COMBINED SEVERE ACUTE RENAL AND RESPIRATORY FAILURE: Forty years ago we (Burman ND, Austin M, Thatcher GN ea) delivered a review of Groote Schuur Hospital experience at a local South  African renal congress on the high mortality of combined  acute renal and respiratory failure in the age of hemodialysis and ventilators, respiratory intensive care, antibiotics and immunosuppression. . Apart from the common major sepsis,  trauma and allergic eg antibiotic  causes, the obvious “primary” cause – which any virus eg MERS-CoV  may mimic- , is the “autoimmune” hypersensitivity Goodpastures Syndrome GPS – which untreated has a mortality of ~80% but with modern treatment perhaps 20%. This is half the deathrate reported in KSA from MERS. There is no shortage of respiratory and renal ICU and dialysis, advanced medical specialists  in KSA centres. So from GPS perspective, much better salvage might be expected.

GPS is rare affecting about 1ppm (0.5-1.8 per million people) per year in Europe and Asia.[5] The peak age ranges for the onset of the disease are 20-30 and 60-70 years.[5]  It is also unusual among autoimmune diseases in that it is more common in males , less common in blacks than whites. This may partly explain why the inhabitants of the dromedary-exporting Horn of Africa have been spared MERS outbreaks.

A recent review from Germany gives the mean time from onset of MERS to acute renal failure of only 11 +-2 days (c0mpared to 20 days in SARS). It is well reported that those contracting acute MERS are already sufferers from major chronic illnesses eg diabetic- cardiorenal-respiratory ie heavily predisposed to  immune failure if not already in renal failure.

Humans have some four  primary excretory/detox  systems: hepato-gastrointestinal; skin; renal; and  lung. In Arabia, water is scarce, the desert climate is hot and dry, and the obligatory dress for the observant almost total body cover by robes. So MERS SARRS is high risk especially as it knocks out the two main excretory systems- renal, respiratory, and in  very high ambient temperatures  also the skin;  except for the affluent minority  who have aircooled spacious private homes and offices;  with  often a reported  element of viral gastroenteritis, akin to influenza. .

The mystery remains: why is the  UAE reporting 73 cases/9.2million ie 8 per million,  but only 12% mortality, compared to the adjoining KSA 721 cases/30 million ie 24 per million?  with 93% of world MERS cases recorded from KSA and UAE, and all cases anywhere traceable back to the Arabian Peninsula. The KSA and UAE urgently need to publish an analysis of the demography and pathophysiology of their MERS cases. Is it mostly indigenous Arabs who are contracting and especially dying from MERS in these countries, or also many foreign workers, mainly malnourished labourers?

A major factor is likely demographic: Wiki says In KSAThere are 20 million Saudi citizens and 5 million foreigners living in Saudi Arabia.[14] Most Saudis are Sunni Muslims, approximately 23 percent are Wahhabis, With the world’s second largest oil reserves , the Kingdom is categorized as a high income economy with the 19th highest GDP in the world.   Saudi Arabia is an absolute monarchy.[70] However, according to the Basic Law of Saudi Arabia adopted by royal decree in 1992, the king must comply with Sharia (Islamic law) and the Quran, while the Quran and the Sunnah (the traditions of Muhammad) are declared to be the country’s constitution.[71] According to The Economist‘s 2010 Democracy Index, the Saudi government is the seventh most authoritarian from among the 167 countries rated.[72]. The ethnic composition of Saudi citizens is 90% Arab and 10% Afro-Asian.[212] Saudi Arabian dress strictly follows the principles of hijab (the Islamic principle of modesty, especially in dress).

In the UAE ie Emirates, Wiki says in 2013  UAE’s total population was 9.2 million; 1.4 million Emirati citizens and 7.8 million expatriate ie  16.6% Emirati (citizenry), 23% other Arabs,  54.4% Asians,  and 6.0% other expatriates. Thus the relatively democratic  & liberal  UAE has only 40% Arab ie (majority also Wahhabi) Muslim  population, compared to  some 90% in the KSA. .    in 2005, 76% of the total UAE population was Muslim, 9% Christian, and 15% other (mainly Hindu). Census figures do not take into account the many “temporary” visitors and workers while also counting Baha’is and Druze as Muslim.[65] Among Emirati citizens, 85% are Sunni Muslim, while Shi’a Muslims are 15%.

The comparable life expectancy in the  bigger but relatively poor mostly caucasian countries of Europe is 80 yrs (Portugal), 81 (UK) to 83yrs , and 84.6 in Japan. Why the richer   KSA has so much lower life expectancy can only be due to combination of culture (overdress?) and perhaps genetics-  but Israel, also a predominantly eastern mediterranean semitic people, like Europe  has life expectancy of  82.1 years. on that tabulation, UAE expectancy is 79.2yrs, USA 79.8, but KSA  only 74.3.

Comparison of Gross domestic product and per capita income for 2014 fail to explain the differences in life expectancy ie survival between the highest earning countries, with KSA, UAE, Israel and much of the middle east countries falling in the $30 to $40 000 per capita income bracket.

NO NEW CASES WORLDWIDE: 4 suspected  MERS cases  investigated in Hong Kong after arriving there  via Dubai have proved negative for MERS.

while Ebola, AIDS, cholera, polio  and bubonic plague spread despite major efforts at containment… with at least USA and UK preparing for ebola outbreak, and China for the  bubonic plague.

8 August 2014  Ebola virus disease EVD update – West Africa  Disease outbreak news     Between 5 and 6 August 2014, a total of 68 new cases of Ebola virus disease (laboratory-confirmed, probable, and suspect cases) as well as 29 deaths were reported from Guinea, Liberia, Nigeria, and Sierra Leone.     On Wednesday, 6 August and Thursday, 7 August, an Emergency Committee  determined  that   the current outbreak constitutes a Public Health Emergency of International Concern. and advised that:                 it constitutes an ‘extraordinary event’ and a public health risk to other States; the possible consequences of further international spread are particularly serious in view of the virulence of the virus, the intensive community and health facility transmission patterns, and the weak health systems in the currently affected and most at-risk countries.

It was the unanimous view of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have been met.   New cases and deaths attributable to EVD continue to be reported by the Ministries of Health in Guinea, Liberia, Nigeria, and Sierra Leone. Between 5 and 6 August 2014, 68 new cases (laboratory-confirmed, probable, and suspect cases) of EVD and 29 deaths were reported from the four countries as follows: Guinea, 0 new cases and 4 deaths; Liberia, 38 new cases and 12 deaths; Nigeria, 4 new cases and 1 death; and Sierra Leone, 26 new cases and 12 deaths.

As of 6 August 2014, the cumulative number of cases attributed to EVD in the four countries stands at 1 779, including 961 deaths. The distribution and classification of the cases are as follows: Guinea, 495 cases (355 confirmed, 133 probable, and 7 suspected), including 367 deaths; Liberia, 554 cases (148 confirmed, 274 probable, and 132 suspected), including 294 deaths; Nigeria, 13 cases (0 confirmed, 7 probable, and 6 suspected), including 2 deaths; and Sierra Leone, 717 cases (631 confirmed, 38 probable, and 48 suspected), including 298 deaths.– mortality rate so far 55%.

For a viral hemorrhagic illness, as for acute MERS and flu,  Ebola treatment and prevention  remains supportive, including plenty of fluids and salts, multivites incl K1,   highdose vitamin C eg a few grams hourly to tolerance,  vitamin D3 perhaps 300 000iu orally to start then 100 000iu weekly, iodine, zinc, selenium, garlic, ginger, ecchinacea and colloidal silver till out of the woods.. . 

29 July 2014  the first Wiki update in weeks  indeed shows no reported increase in KSA cases with 41% fatalities; but total Arabian Peninsula cases up to 825 with 321deaths  ie 39% fatalities, and  96.3% of global – 855 cases and 331 deaths ie 39%.

 28 July 2014 THE END OF THE ARABIAN MERS CoV OUTBREAK? its now apparently 18 days without new MERS cases reported from KSA , compared to 6 cases in the previous week… .              so the Wiki figure of WHO-reported cases  in the Arabian Peninsula (plus the 2 recent cases in UAE)  totals 814/(835 globally  ie 97.5%  of reported world cases),  with 315 Peninsula  deaths ie 38.7% fatality rate- but only 13% in the  far less coverup- restrictive UAE with its huge foreign worker population. . . supporting the studies of KSA scientists  of more severe vit D deficiency in the most covered-up observant people, citizens of Saudi Arabia and its fellow ultra-observant Wahhabi bordering neighbour states (except the UAE)  to the south and east. .

and now Ebola epidemic outbreaks kill hundreds in central Africa.  The nocturnal fruit bat (that locals eat)  is apparently the vector. There is strong reasoning that these could be prevented, successfully treated (humans if not bats) with safe highdose vits C and D3.  Like humans, all tested families of bats, including major insect- and fruit-eating bat families, cannot synthesize vitamin C,.    and have very low vit D levels,  make vitamin D only if they roost in sunlight.

and Central Africans are very darkskinned, and the masses malnourished from rampant  genocidal wars, so they will have the lowest levels of vitamins C and  D3. 

20 July 2014  MAYBE..  JUST LACK OF REPORTING?          ‘s A Time’s Memory   to 17 July shows  17  more reported MERS cases (all outside the KSA -still 721  cases, 297 deaths): globally 852 with 329 deaths;   Arabia 829 with 319 deaths; ie rest of world 23 cases and 10 deaths-  similar mortality 41% in Arabia compared to 43% in the 23 infected cases who returned to  their own countries  (middle east, north Africa, Europe, USA, Malaysia, Philippines) not on  the Arabian peninsula- from  their visit/working  there or,  rarely, contact with returnees. .  So has the outbreak  stopped in the past 10 day

ps the USAEBN radio website reports startlingly different case numbers in far fewer  nations, especially tenfold more cases  in Qatar and half the number in UAE.  Time will tell. . this high occurrence in Qatar is not reported anywhere else? on 24 July it reports for KSA alone  834 Cases (897 in the Arabian Peninsula); 288 Fatalities. globally 873 cases with death rate only 35%.      still the massive discrepancies with startlingly far more cases in Qatar and Philippines and far less in the UAE. This website claims, perhaps not implausibly,  that “Government Organizations Do not want to publish total numbers of cases for fear of panic, USAEBN will be trying to track it.”

Virologist Dr Ian MacKay IN MID JULY  puts the world total of cases at 846 in his informative analysis of age and gender demography.

But with neighbouring Iraq in civil war breakdown and even polio flareup, who knows how many there are suffering and dying from unmonitored  MERS CoV.

14 July 2014  The UAE reports 2 new cases of MERS CoV – the first in a long time-, bringing their total to about 73 cases, 9 deaths ie 12% fatality. . KSA reported one new case 10 July ie  4  past week, and 5 in each of the  the  previous few weeks; with no deaths, tally now 721 cases, 295 deaths ie 41%.                       The UK Gov travel warning is about terrorism in the region, not MERS.

The vexed question of the method of spread of MERS CoV between animals- dromedary camels- and humans  continues to be hotly debated between expert virologists and camelmen. The KSA has still not issued [ any restriction on camel imports from the suspected source of the MERSCoV- the Horn of Africa.

But the argument is irrelevant for practical purposes.  Tradition, belief  dies hard, like the strictly enforced hijab overdress, and camelkeeping: Riyadh’s camel market stretches several miles along a highway out of the city. It’s not true. Camels occupy a special place in Saudi society,  We live,  sleep,  eat and spend our whole lives with camels, we drink their milk, its a medicine.. There’s no disease,” said a trader at the market”.       Its the story of 160 years ago, the cholera-spreading London’s  Broad St water pump until Dr John Snow recognized and stopped the source of the cholera diarrhoea epidemic.   This  far more lethal KSA  lung-kidney epidemic is simpler- encourage people worldwide to get plenty of free natural sunshine , or if living at far north darker  latitude or  practicing hijab and unable to sunbathe- especially over Ramadan- take at negligible cost  vigorous supplement of vitamin  D3 to a high safe  bloodlevel .

8 July 2014  Spread of MERS CoV- Down but not out: from 15 cases a day in early May,  now KSA has reported  8 new cases past 7 days;   ie 720 total, 294 deaths- 4 new cases past 3 days, with 1 new death. 18 new cases in 24 days since 13 June. So the rate of new cases is not dropping there the past month – or simply more cases being tested and reported. Only sick cases who see doctors, and their contacts, and city  health workers,  are likely being screened.

The death rate in KSA  since the outbreak 2 years ago remains 40%.      why should this be? other than that Saudis do not benefit from the midsummer as do other populations-  they remain shrouded in overdress and thus severely vitamine D deficient? and the virus seems to spread not airborne  but by direct contact – human to human, or camel-(milk?)-human?  and the KSA has not yet been reported to have stopped mass camel importation from the Horn of Africa for butchers to supply meat.

MERS CASES BY OCCUPATION:     Shane Granger has tabulated more recent reported MERS  cases by occupation where data is available  –  >375 cases:Health Care Workers (HCW) the  largest group – 161:  includes all types of unidentified Health workers (i.e. Nurses,  Doctors, hospital and clinic staff).                             Retired: also  161 (incl Pilgrims 11).                                             Schoolkids 18 -third. Farmers 12 – fourth.  .  tourist 3; construction 2;  Camelbreeder, butcher , shepherd one each.

The retirees are the elderly, generally frailer, probably more at leisure, more orthodox ie more ritually overdressed?  and circulating /concentrated more through/in  the cities especially Mekkah, Riyadh,  Jeddah, and visiting the more frail and sick worldwide; thus more susceptible.

Healthworkers are obviously the most stressed and hardworking,  exposed to concentration of symptomatic MERS cases and thus ingestion and surface (if not droplet) contamination .

The major surprise is the low occurrence in schoolkids, pilgrims, and non-health industry workers, teachers, clergy, armed forces,  shop  and office staff, non-healthcare  govt workers,    etc.

This also favours nutritional ( sunlight/vit D/C/zinc) deficiency as a significant factor in susceptibility of retirees and healthworkers to MERS. The general population (unless seriously ill with other disease)  is largely immune to MERS, like flu and common colds, in them  the MERS CoVirus seemingly causes nothing more.

4 July 2014  frail pilgrims  should postpone the Hajj this year.  the  European Centre reports     KSA 716 cases, 293 deaths;    worldwide 843 cases (817 in Arabia incl now 4 in Iran), 322 deaths. in 21 countries, ie 21 cases outside the Middle East (ie outside the camel contagion area  south-east across the Arab states that have had 791 cases so far)  .  So thats about 10 new cases over the mid summer  in KSA the past 15 days so far. Only 1 new  death.  Case reporting from the rest of the world lags behind.

So the Philippines has advised its citizens to postpone Hajj to Mecca this year.

Certainly  frail pilgrims – especially with diabetic and cardiorenal/respiratory diseases -all over the world will be wise to  postpone. And the KSA is at last considering stopping import of camels (4.7 million a year mostly for human consumption,  – mostly from Somalia, which has never reported a MERS case) –  from the Horn of Africa- their main meat supply. This appears to be the source of the outbreak- simply camel colds that kill only sickly humans who unlike camels avoid sunshine by edict… .    Up to April 2014, it was predominantly a disease of older men; (it appears that camels are men’s work);  but by midMay the male dominance in human MERS cases was fading.

But is the core problem the well-camel MERS-Covirus carriers? It is in fact more likely that the prime cause is that the entire KSA population is at extreme risk – both because those who can afford it overdress by religious edict, especially upperclass Muslim women in total coverup and thus badly vitamin D deficient;  and  because the KSA imports vast numbers of mostly poor unskilled foreigners to do mostly manual work. Such poor labourers are usually undernourished, living in poor conditions, and with poor access to medicines and medical care until they collapse; and unless outdoor labourers, living and working long hours indoors, and hence also badly vitamin-D and C deficient. .   The Wiki review  Saudi Arabia  “Foreign workers estimated them to number 1/3 of KSA residents recently.  Saudi Arabia has become increasingly dependent on foreign labour, and although foreign workers remain present in technical positions, most are now employed in the agriculture, cleaning and domestic service industries. The hierarchy of foreign workers is often dependent on their country of origin; workers from Arab and Western countries generally hold the highest positions not held by Saudis, and the lower positions are occupied by persons from Africa, the Indian subcontinent, and Southeast Asia.  the situation has persisted because of a reluctance by Saudis to take on menial work and a shortage of Saudi candidates for skilled jobs.[.. The Saudi economy has, therefore, remained dependent on importees for expertise in specialized industries, and on the Asian workforce for the construction industry, menial and unskilled tasks.[8]  Saudization is generally considered to have been a failure.[10]

THE MERS-CoV CAMELTRAIN FROM AFRICA:   This again begs the huge question:  if camels carrying asymptomatic airways MERS CoV are indeed the virus vector from Africa –  almost 5000 a year from Somalia alone- imported into KSA  through Jeddah port,  WHY ARE THE  EXPORTING  CAMEL- TRADERS and camel- breeders IN NORTH AFRICA NOT  SUFFERING vastly from MERS  respiratory-renal syndrome?  They are likely Muslim if not black Africans;  oil-rich Arabia employs vast numbers of overseas expats as labourers, and outside the KSA, Arabia especially the UAE  hosts hundreds of thousands of non-Muslim professionals. But unlike say Indians and other Asians, Pinoys and Malaysians are mostly Muslim, so are more likely to observe cover-up dress code,  and thus be more vulnerable to MERS. . This again supports the evidence that   the current symptomatic serious MERS-CoV   SARRS – Severe Acute Respiratory Renal Syndrome –  that occurs in and kills almost exclusively vit D deficient frail observant Muslims  – is due to conditioned  sunlight deficiency.          The north African camel breeders and traders, and  the camel herders and camel men in Arabia  ( like cowboys on the prairies and herders worldwide in hot  climates), are unlikely  devout well -berobed  Bedouin  of Arabia.  Camelmen like cowboys get  plenty of sunshine vit D, if only via bare faces and arms; and thus can with probable impunity,  immunity against MERS, drink raw camel milk and travel with vast camel herds.

27 June 2014 update: (compared to  13 June 2014 KSA  702 cases, 292 death, worldwide 826 cases, 326 deaths): there are now reported in KSA 710 or 718 cases ie 8 -16 in 2  weeks, no more deaths; and globally  833 cases & 322 deaths. . Australian virologist Dr Ian Mckay postulates why vast camel imports (from Africa, via Jeddah  port)  for eating  is likely the source of MERS in Saudi Arabia.                 He omits the obvious link in the chain, that the deathrate from MERS CoV is far  lower outside Saudi Arabia because  this sunny  country is the strictest in the world for enforcing Wahhabi hijab total overdress code   and thus profound acquired vitamin D deficiency even in men,  and worse in  females who  in public  – unlike men- must have even their  heads and faces veiled by a niqab- and in pilgrims from other lands who as part of  their holy pilgrimage undertake to follow permanently  the strict hijab dresscode. Their simple option is  to take effective permanent  vitamin D3 orally  eg 50 000 iu weekly.

IT IS COMMON CAUSE THAT ONE DOESNT, CANNOT   PREVENT OR TREAT INFECTION BY POOR NUTRITION OR LOWDOSE ANTI- MICROBIALS- such policy is futile if not dangerous for breeding resistance as well as disease extension.   The studies below confirm the obvious, (as Klenner, Pauling,  Cameron ea showed the past 50 years with highdose vit C injection), that  vitamin D3 orally also works as a multiantimicrobial agent if given as early as possible in safe very high dose and bloodlevel eg 600 000iu monthly (in the first month, – in Salahuddin’s  Pakistan PTB patients (presumably also Sunni muslim) initially mean wt 45kg, thats vit D3 ~440iu/kg/d) for two doses ie a mean of 300iu/kg/day over 90days;   not the current preventative recommendation of 80iu/kg /day to a safe blood level of around 50-60ng/ml. As Holick has said, with adequate water intake  even 50 000iu vit D3 a day ie 1.5million iu/month for months causes no toxicity. Given the 40% mortality rate in the frail Saudi MERS patients, and in acute severe influenza and other serious viral infections, it can be expected that such  highdose immediate vitamin D3 therapy orally with eg 600 000iu, combined with highdose vitamin C, zinc and some multivite,  (never mind appropriate antibiotics in acute bacterial infection) will similarly virtually eliminate mortality.

But no KSA Govt website mentions this- except the Saudi Gazette a year ago which strongly urged vitamin D supplement in the KSA as even daily sun exposure does not bring most Saudi women above the vitamin D deficiency threshold. It says Since Muslim women can only reveal the hands and face, they may need to be out in the sun for longer than 30 minutes. But the review conspicuously  fails to mention that in public outdoors in KSA, women must have even the head and face covered. It also  propagates surprising  dangerous  nonsense that “severe deficiency needs monthly vitamin D injectionMom, have you taken your vitamin D injection this month?, when all it requires is an oral daily, weekly  or fortnightly  dose vitamin D3  at trivial cost.” It does stress  “One of the main reasons why vitamin D deficiency is so common in the Kingdom is because there are very few food sources of vitamin D. Foods which have fairly good amounts of vitamin D are fish liver oil, sweet potatoes, egg yolks, vegetable oils, butter, and fatty fish such as salmon, sardines, and tuna,” said Dr. Rasha Jameel, a consultant in family medicine at a local hospitalIn the United States, all milk and dairy products are fortified with vitamins A and D, but no such measures are in place in the Kingdom“.

This correlates with a new metaanalysis (in the  BMJ this month) of observational studies from Europe and USA, that all-mortality hazard ratio over a mean of 10 years  increases by 57% as vit D level falls from the highest to the lowest level. The KSA apparently chooses to ignore that, as this column reported recently from WHO data, despite  apparently being the wealthiest country per capita  of bigger populations  in the world,  KSA’s population life expectation is about 5 years lower than eg far less sunny Britain’s; ie KSA  all-cause mortality rate is avoidably materially higher. Despite KSA medical professors  having reported in studies  that most of the KSA population is deficient in vits D and C, the  KSA Govt website  chooses to ignore this on official websites;  unlike other even Middle-Eastern governments promoting vit D fortification or meaningful safe supplements costing trivial amounts.

Even a new study last year from KSA universities confirmed that ” Most commonly consumed food products by Saudi population which are supposed to be fortified by vitamin D are either not fortified or contain an amount less than  (apparently  from their table 2 ~ half of)  recommended by guidelines set for US marketplace”. Even a UAE authority recently stressed “Can fortified milk fight Vitamin D deficiency? Shockingly low levels of D3 among UAE population cannot be rectified by milk alone.” As Holick ea, including  a Turkish University 2010  trial report,  oral vitamin D3 is far more  effective , and safer than,   either vitamin D2, or vitamin D injection -never mind much cheaper. This current ostrich-head-in-the-sand denialism by the KSA government is like that of the RSA govt under Presidents Mbeki and Zuma 10-15 years ago about preventing and treating HIV-AIDS  – considering that the safe and beneficial daily intake of vitamin D3 is now universally recognized as 4000 if not 10 000iu/day (ie about 80iu/kg/day or pro rata up to perhaps fortnightly) , to a mean blood vit D  level of about 60 to 80ng/ml. .

As Prof Mike Holick pointed out a few years ago, “Even in Saudi Arabia, Qatar and South Africa, more than 50% of the population is deficient in vitamin D, all because of their avoidance of sun. Based on some of the literature, it seems that we could probably decrease health care costs across the board by 25% if everybody had optimal vitamin D status.” As Al Faraj ea reported in Riyadh in 2003,   Prof Zahid Naeem from a KSA university wrote in 2010,Vitamin D deficiency is an ignored epidemic in KSA  and globally“; confirmed by a KSA study by Ali ea in 2012:Even in a sunny country like Saudi Arabia the prevalence of vitamin D deficiency in young female is high“..  One does not need to  speculate why the KSA and all governments globally choose to ignore this inconvenient truth,  downplay effective vigorous  vitamin C and D3 (sunshine) supplements-  such widespread vitamin D and C deficiencies, like cigarette smoking and alcohol abuse,   suit governments and Big Pharma-  the Disease Industry- in reducing populations growths and creating jobs for the highly profitable Disease Industry and it’s shareholders-   for whom Only Disease Pays. Cheap safe natural  Prevention Does not Pay since it at least halves sickness never mind disease industry jobs, taxes  and profiteering in the global $multitrillion Disease and Diet and Vaccine and Invasive Screening Industry scams.

And Karen Hansen ea at Univ Wisconsin 2014 have  just shown  that  giving vitamin D2  (not D3)  50 000iu fortnightly for a year is actually adverse – as Holick and others have  show – IT DEPRESSES – perhaps halves – THE BIOLOGICALLY ACTIVE blood 25OHVIT D3 while boosting perhaps 5 fold the far less active blood 25OHvit D2 levels , and actually worsens  rheumatoid arthritis clinically and serologically . One can speculate whether vit D2 actually blocks optimal function of VDRs vitamin D receptors. Trials published 2012 from Japan and Netherlands showed that vitamin D3 – blood 1,25(OH)2D3 (but not TNFalpha blockers) blocked  inflammation (ie TNF tumour necrosis factor alpha activation of vascular calcification).                                                 

Salahudfin ea’s new randomized controlled trial  from Pakistan Vitamin D3 injection accelerates clinical recovery from tuberculosis  shows “impressive clinical (weight gain, chest xray and sputum clearing)  improvement  over 3 months on outpatient TB therapy (Directly Observed Therapy (DOTS) with 2 months of 4 antituberculous drugs [Isoniazid, Rifampicin, Ethambutol and Pyrazinamide] followed by 6 months Isoniazid and Ethambutol)  with two doses 600 000iu vit D3 imi  (vs placebo inj)  a month apart-  ie equivalent to about 7 000iu/day over the 3 months treatment period . This dose  of vitamin D is as recommended for vitamin D supplement by the Pakistan Endocrine Society.  Trough  25OH vit D levels increased from about 20 to 90ng/ml.    After 12 weeks, the vitamin D supplemented pts (mean 28 yrs, BMI 17.2kg, 85% moderate to far advanced lung disease)  had  significantly greater mean weight gain (kg) + 3.75, (3.16 – 4.34) versus + 2.61, p 0.009; lesser residual disease by chest xxray-  30% fewer zones involved 1.35 v/s 1.82 p 0.004,   and 50% or greater reduction in cavity size 106 (89.8%) v/s 111 (94.8%), p 0.035. Vitamin D supplementation led to significant increase in MTBs-induced IFN-g secretion in patients with baseline ‘Deficient’ vitamin D serum levels (p 0.021). Patients in the vitamin D arm and serum < 30 ng/mL (‘Insufficient’ and ‘Deficient’ groups) at enrollment had significantly greater improvements in TB severity scores compared to patients with normal baseline vitamin D levels; p 0.014. This corresponds with the earliest reports of the benefits of vitamin D in TB patients published in 1848 [21] that describes disease arrest, weight gain and reduction in mortality in patients with TB treated with cod liver oil compared to standard therapy alone. More recently, Martineau et al  [7]  demonstrated that a single oral dose of 2.5 mg (100,000 IU) of vit D2 significantly reduced growth of mycobacteria . A randomized, placebo controlled study on 67 Indonesian patients, by Nursyam et al , Jakarta  [22] reported that pulmonary TB patients given 420,000 IU of vitamin D over 6 weeks  ie 10 000iu/day had significantly higher sputum conversion rates as compared to placebo (p 0.002). Martineau et al. [8] showed that 100,000 IUs of 25-hydroxyvitamin D3 supplementation significantly improved sputum conversion rates in patients with the Taq1 25-hydroxyvitamin D receptor polymorphism of the tt genotype.                                                                     .        

            As Salahuddin ea note, the good results in Pakistan in only 3 months with vigorous  INITIAL dose vit D3  contrasts with Two recently published large randomised, controlled trials of conservative vitamin D3 over months  that achieved far lower blood vitamin D levels found no difference in clinical outcomes or mortality:           after 400,000iu of 25-hydroxyvitamin D3 or placebo were given by   Martineau ea  in London, UK to 146 pulmonary TB patients – where mean (trough  or midpoint)  vit D level  (after 100 000iu vitamin D(3) or placebo at baseline and 14, 28, and 42 days after starting standard tuberculosis treatment) – was surprisingly only  40ng/ml at 56days – ie after a mean of 7000iu/d by  56 days,  vs 10ng/ml  on placebo)- less than half of the bloodlevel  achieved on vit D3  in the Pakistan trial ;      

        and  by Wejse et al  2009  in  Guinea-Bissau to 365 TB patients  – who received  300,000 IUs of vit D3   ie only 100,000 IU or placebo at inclusion and again 5 and 8 months after the start of treatment,  ie below 1000iu vit D3 per day over the 12 month trial period “. The Guinea-Bisseau pts thus might have achieved a mean blood vit D level boost of only  10ng/ml.. and now Havers ea (Baltimore)   show Low 25(OH)D is common in diverse HIV-infected populations and is an independent risk factor for clinical and virologic failure; Low 25(OH)D was associated with high body mass index (BMI), winter/spring season, country-race group, and lower viral load. Baseline low 25(OH)D was associated with increased risk of human immunodeficiency virus (HIV) progression and death (adjusted hazard ratio (aHR) 2.13; 95% confidence interval [CI], 1.09–4.18) and virologic failure (aHR 2.42; 95% CI, 1.33–4.41). and Shepherd ea (Eurocoord) Low Vitamin D predicts short term mortality in HIV-positive persons Odds of death decreased by 46.0%( P = .04) for a 2-fold increase in latest 25(OH)D level.. In patients with current 25(OH)D

19 June 2014 update  no new cases reported from anywhere the past few days, may be because the KSA is not reporting regularly.   so the great news is that more than 2 years after the onset of the MERS CoV outbreak in Arabia, no ongoing transmission has been reported from any of the 22 countries so far affected.

THE POLIO  SPREADING GLOBAL EPIDEMIC This decline of the MERS outbreak with the heat of summer contrasts sadly with the now-declared  global epidemic of wild natural  poliomyelitis which was hoped to be extinct by now, with Hindu- run India being declared polio-free; but now  spreading out with mass refugees from wherever war and chaos are successfully ignited by profiteers and fanatics  to neighbouring countries. Eg   an expanding militant  Islamic Wahhabi  arc – ie ultraorthodox overdress code – predisposing to vitamin D deficiency?  from Asia– Pakistan, Afghanistan, to middle east – Syria, Palestine, Iraq, Israel;        to East/West Central Africa eg Somalia, Cameroon, Ethiopia,  Kenya, Nigeria, Guinea-Bissau, –  with 365 cases reported in 2013. Perhaps more important is zero natural virus cases in Niger and Chad but cases caused by the circulating vaccine derived virus.  The wartorn  DRCongo  and Sudan are likely next polio outbreaks, while Angola has banned Islam because of its perceived militancy. …

And in February,   never mind an outbreak of polio-like paralysis in northern California, a new case was  reported  in a  South African neighbour-  in Botswana – for the first time there  in 20 years –; “Polio virus is endemic in five countries besides Nigeria: Afghanistan, Egypt, India, Niger and PakistanScientists confirmed that the virus isolated from the boy in Botswana came from Nigeria by laboratory tests that showed it was genetically similar to the strain that has been infecting children in Nigeria . In the past 18 months, polio viruses genetically linked to northern Nigeria have caused new cases of polio in nine previously polio-free countries. Besides Botswana, they are Benin, Burkina Faso, Cameroon, the Central African Republic, Chad, Ghana, Ivory Coast and Togo.” So polio is likely to break out in RSA  not because of Islamic overdress but because of the masses of war refugees absorbed by democratic dispensation  from the polio-afflicted African states to the north, and poor water supplies, sanitation and nutrition,   in so many areas in the northern provinces, despite mass polio vaccination. . In Cape Town’s poorer  areas’  clinics, we see almost as many foreign pan-African refugees as we do local black Africans.

VITAMIN C & D AGAINST POLIO: but as with flu, HIV, TB and likely all infections, the rescue remedy that the Disease Industry  firmly ignores  is freely available also against polio (and all other infections –  as shown so successfully by Dr Fred Klenner after WW2 with highdose vitamin C);  and at least two  published studies  in modern times ie on Pubmed (FDA- Ivanov 2006 USA)  shows the predictable enhancement by vitamin D3 as an adjuvant  of immune response to vaccine against  poliovirus- presaged by a 1949 paper from Foster ea Univ Pennsylvania . .

15 June 2014 new case reported in the 23nd country – Bangladesh, arrived from USA via Abu Dhabi airport. But now disproven. CRUCIAL EFFECTIVE VITAMIN D3 DOSING: TRIALS USING SUBOPTIMAL VIT D DOSES AND LEVELS ARE MISLEADING:            A major new  metaanalysis of the benefit of Vitamin D and Respiratory Tract Infections VIDARIS in PLOS 2013  by Sweden’s Karolinska  Institute Bergman ea showed that in the 11 relevant trials (published between 2007 and 2012 ie done through the first decade of this century) using vit D3, “Overall, vitamin D showed a protective effect against RTI (OR, 0.64; 95% CI, 0.49 to 0.84). And the average vit D level at baseline was only 24ng/ml, but with the mediocre  vit D3 doses used then  of average 2000iu/d (300 – 4000iu/day) given for between 7wks and 3 yrs, the average bloodlevel achieved on replacement was only 50% higher at 36ng/ml”.      This confirms more direct experience  with higher doses that blood level increment, and benefit,  is proportionate to vit D3 dose, at least up to the proven speculative  safe upper dose of at least 10 000iu/day (whereas the proven safe longterm daily dose is> 50 000iu/day). “More important, the protective effect was larger in studies using once-daily dosing compared to eg monthly  bolus doses (OR = 0.51 vs OR=0.86, p = 0.01)”. This concurs with our experience of major benefit  against respiratory infection that is  based on published studies giving a loading month’s dose of about 80-100 iu/kg/day  ie ~3000iu/kg; then that monthly dose split conservatively eg 50 000iu every week or two depending on mass, and severity of ill-health; to a more successful blood-level of 60 to 100ng/ml. Similarly, the  2014 VIDA trial   across USA-    Effect of Vitamin D3 on Asthma Treatment Failures in Adults With Symptomatic Asthma and Lower Vitamin D Level, Castro ea,  showed “Vitamin D3 for 28 weeks did not reduce the rate of first treatment failure or exacerbation in adults with persistent asthma and vitamin D insufficiency. These findings do not support a strategy of therapeutic vitamin D3 supplementation in patients with symptomatic asthmaBut this trial had the same severe limitation as the Swedish metanalysis of vit D3 benefit- it also used only 4000iu/d. “While all were vitamin D insufficient ie below 30 ng/ ml  before the trial and half were deficient with levels below 20 ng/mL, supplementation brought levels above the 30 ng/mL threshold for 82% in that group – mean levels were 41.8 ng/mL at week 28 in the supplement group, while the mean stayed in the deficient range for those who got placebo. ”  So 4000iu/day merely doubled the bloodlevel to only about 40ng/ml – only about half of the putative optimal dose.  These recent studies force us to conclude that bad weather, and  bad prevalent respiratory viruses,  and especially with major acute, or chronic illness as in those with or at risk of serious infections eg major trauma or sepsis,   MERS-CoV, Ebola, malaria, cholera, cancer, diabetics, smokers, asthmatics, bronchitics,   AIDS-TB., pneumonia and old age  sufferers, and especially hospital, laboratory  and clinic- health workers-  we should for an average 70kg adult give a loading dose of about 4000iu/kg, ie 300 000iu, then 10 000 iu/d,  or 50 000iu every 5 days, or more simply 75 000iu (about 1.5ml of 100cws vit D3 powder) weekly; or at a stretch, 300000 if not 400 000iu monthly. . As  the common  imported vit D3 powder concentrate  is 100 oooiu / Gm ie per 2 ml, it is simple to take the slightly sweetish powder up to  2 or more 4 ml teaspoons ie 200 000  -400 000 iu on the tongue.    The majority of residents of developed countries now live urbanised with mechanized transport, and – especially in Muslim or cold countries-  dont  live and work / walk  all day stripped in the sun. The poor malnourished  peasants  live crowded in ghettoes , and  the poorest are generally the darker skinned and therefore make the least vitamin D3. So with rare exceptions, everyone needs the vigorous vitamin D 3 doses discussed above. But at the prevalent bulk vit D3  powder price of  at most about  US$0,o2 per 100 ooo iu, at a mean population age of around 20 to 25 yrs -outside  Europe- it would cost a country of eg 50 million people perhaps $o.5 per head per  year ie conservatively $25 million a year to prevent > 90% of common illnesses including drugging and violence consequences.  Of course no government can tolerate  such massive loss of jobs and taxes  in a decimated disease industry that now turns over $ trillions annually – up to 18 % of national budgets.     So it’s up to individual adults, especially householders, educators and employees ,  to see that the cheapest cure-all  after clean water – vitamin D3 – at $2/citizen per year-  is recommended and freely available.

13 June 2014 KSA now has apparently reported 702 cases, 292 deaths ie 14 more cases, 12 more deaths in past 11 days.. worldwide 826 cases, 326 deaths. And a new multinational vitamin D study  confirms why vitamin D3 not D2 must be given. TIME TO SWOP FROM MISNAMED  “STRONG CALCIFEROL” VIT D2 TO THE REAL VIT  D3. 6 June 2014   on the 10th anniversary of the SARS epidemic , a new 2013 review (by Japanese epidemiologists) Remembering SARS-CoV: A Deadly Puzzle and the Efforts to Solve It brings home the lessons, the similarities between the two recent killer coronavirus outbreaks, in both outbreaks affecting only residents of closed communities (Arabia and China respectively), with carriage of the virus by travelers into their closed kin communities elsewhere. .  Especially the problems of hospital confinement, and superspreaders.          Sun-blocking culture among the Chinese whereever they live in their ethnic communities is also stressed in modern literature. Lu et al 2012 show very high levels of vitamin D deficiency in Shanghai. The  obvious lesson of the past decades was not noted then or now- prevention is better than cure, as in AIDS and pneumonia and all other infections, simply by superboosting the immune boosters within sensible limits –  sunshine/vitamin D3 and C, zinc, iodine, selenium; and for the likely deficient, appropriate iron .. 4 June 2014. Saudi Arabia reports confirm they have indeed  uncovered many more cases, as tabulated by the Wiki report yesterday- 689 cases, 283 deaths. Shane Granger in his Random Analytics concurs. The graph by the KSA authorities shows that most of the unreported cases reputedly occurred from March through to the first week of May, and that that outbreak is almost over, down from a peak of over 100 cases a week ie at the end of their winter- when vitamin D levels are at their lowest-  to about 25 cases a week. .They do not say when the excess MERS-related deaths occurred. Who knows how many more cases and deaths are underreported from the KSA, when the annual Hajj is imminent, and religious tourism is a vast industry for the KSA. This  MERS outbreak is in contrast to  the 8200 recorded case SARS (coronavirus) outbreak of 2002/3 in China, S.E.Asia, (Canada and USA)  and sparsely across Europe – but only 1/4 of the MERS’ ie  9.6% mortality . Just one case was recorded in the middle east and Africa- in Kuwait. Although the SARS and MERS  viruses were traced through mammals to bats, the affected populations were genetically  different-  Chinese  versus Arabic ie Caucasian. But a decade after the SARS outbreak, Chinese in Shanghai also had 85% below the vit D insufficiency threshold (30ng/ml) at the end of winter.  An International Osteoporosis Foundation study of 2009 showed very high prevalence of vit D insufficiency throughout Asia including China- but worse in Malays. Thus the susceptibility to and mortality from SARS and MERS  in the respective races- like Swine flu susceptibility in the frail in USA and Mexico in 2009 and anywhere since-   is likely due like any disease to the combination of both socioeconomic  burden, genes and sunshine vitamin deficiency. But whereas socioeconomics;  genes; and ethnic taboo on sun exposure as in strict Muslims,  are not easily correctable,  traditional micronutrient deficiency is- especially vigorous vitamin and mineral  supplements, without offending cultural taboos.                                                                  

3 June 2014 update :   In the past 5 days, Google websites  reported 2 new  cases/d in KSA.  BUT Wikipedia this evening reports the latest collation: in KSA, 688 cases with 282 deaths ie 41% mortality; this is far higher than in its close 7 Arab neighbours  including Iran, with a total of only  89 cases but only 26% mortality. If these figures are accurate, there have apparently been 125 cases in KSA since 29 May ie 25 new cases/day there; but 96 deaths ie 19 per day. But this gross epidemic has not been reported on Google, so hopefully the Wiki MERS tabulation will be corrected- unless it because the KSA was not announcing cases. .  Apart from the 8 Middle East nations counted above, the Wiki  figures for the outside 16 countries in the rest of the world  – 25 cases,  7 deaths ie 28% mortality, are more consistent with reports to date outside KSA, and moderately lower than  the fatality rate reported in KSA . All MERS- confirmed cases were contracted in the Arabian peninsula (or from travelers from there). All adults  in the KSA including visitors  would by edict be  almost totally robed  when  outdoors, the women also with hijab. On the other hand,   observant pilgrims from non Arab countries are more likely both older-  having chronic degenerative diseases ie more vulnerable- , but  likely  get more sunshine skin exposure at home,   and taking protective supplements before and after; thus possibly explaining  the lower mortality and low  prevalence of carriage of MERS outside Arabia.  The average  Saudi Arabian is aged around 20years, but  the young there presumably  face the same policy   against skin sun exposure,  and apparently against protective micronutrient supplements. 31 May 2014  Mers update   the past 2 days just one new case in Saudi Arabia, but 2 cases in Algeria back from KSA  the 21st country ; and now a total of 6 cases in Iran with 1 death.

29 May 2014: The 26 May Cape Town suspect’s  deep nasopharyngeal swab screens  have proved negative for Influenza A eg swine flu, and MERSCoV, and she is recovering. . The NICD says they have perhaps  5 requests for screening in returnees from KSA, all negative for MERS CoV. KSA reports 3 new cases past 48hrs ,  while of recent screened cases there, 4 more  have recovered and gone negative. ie  565 cases , but 6 more deaths ie 186 died –  33%;                Worldwide  thus at least 680 cases / 215 died. But apart from KSA and Jordan (5/10 died= 55%) the fatality rate in the other 19 countries reported is thus  also 22.6%, as low as 13% mortality in UAE if their figures are to be believed.  The problem is we dont know how many subjects were screened in each country to get the perspective.. Perhaps UAE simply screened many more ‘well’ people with “flu’. of recent cases reported from countries outside Arabia, virtually all presented clinically with serious URTI.  Only 2 MERS-COV cases have been finally confirmed in USA, both travelers back from KSA. Thus it is apparent from all the screening patchily reported  the past 2 years that:                                                                                                                                                          1. air/physical contact  crossinfection between humans (as between camels and humans)  is common; 2. but resultant  actual colonization (ie the asymptomatic MERS CoV carrier- akin to say the common staph nasal carrier)  is reassuringly low- likely in mildly immunocompetent people with suboptimal   vigorous eg vit D3 levels and intake of vits C, zinc etc; and  cleared naturally within days; 3. BUT of those colonized with  invasive MERS CoV  who actually present sick enough-ie with MERS–  (generally those with  comorbidities) to consult doctors, mortality may be > 50% (as eg in KSA,  Jordan, Qatar, UK) – likely because they have poorly controlled diabetes, HIV, heart/lung/kidney disease;  or very low vit D3 levels and very low intake of vit C, zinc etc. 4. So far survivors of MERS  apparently do not stay carriers of the virus. These observations will be simple to affirm/ refute by storing, or immediately testing, all carriers’ and cases’ blood  for 25OH vit D3 (albeit expensive)  as well as the other obvious markers  . But it is harmless and virtually cost-free to treat all such people anyway with vigorous vits D3, C and zinc against all latent/patent  diseases. Parallel experience with seasonal flu/ common colds  is that while the URTI  may have been protracted till the patients consult, virtually all cases quickly resolve with vigorous supplements (vits C, D3, iodine, multivite,  appropriate iron, and appropriate decongestants/ “vix” steaming. And of course it is simple and appropriate to deep-sniff pure vit C + D3 powder- as easy as using a nasal sprayer. .                                                                                                                         27 May 2014  Jordan reports  a  fresh (10th) case;      KSA  now 562 cases –no new cases, but one  more death;   national  school exams start there irrespective.. so global total now may be 650..now   2 in Iran. – – the 21st country?. Its not to say that >650 people have caught the illness,  since apart from 30% who died of MERS , at least 20% were well, found only on viral swabs of contacts, ie by definition did not have the MERSyndrome that has killed 30%.. The  global  authorities have not revealed how many of the balance of 50% of those who screened positive actually developed any flu-like symptoms, as opposed to those who survived pneumonia & renal failure. Vigilance is necessary everywhere since both seasonal (H1N1) flu is spreading in the southern hemisphere, and MERS from Arabia with the recent peak there, and business, social and umrah travelers pouring through the Middle East  hubs- especially to and from the worldwide Muslim diaspora , and trade hubs, . . “If you get sick within 14 days of being in the Arabian Peninsula, call a doctor and tell the doctor where you traveled.” said an NBC report earlier this month. 26 May 2041 Our  first ‘ground zero’ MERS suspect returnee from Riyadh  today screened in Cape Town?:  after a weekend with  my own flu attending a 3day medical congress here, and bad family news last night, I was caught flatfooted this morning at a  walk-in local family practice clinic full of people with sudden flu/gastro gripes: the first lady  in (robust, no chronic illness)   with usual sudden  overnight flu   had after two weeks visiting her family in KSA, jetted back from there   just two weeks ago, having sat  behind a man coughing and spluttering.               Before starting highdose  supplements etc, she was  deep nasopharyngeal swabbed for flu and MERS  exam  by our South African National Institute for Communicable  Disease.  Then we will,  if she/her family prove positive,  contact the airline to start tracing all passengers and contacts here. She is hardly in the  risk category that has rocked the KSA. We dont know yet about her flight fellows..

25 May 2014:  HOPEFULLY THE MERS SURGE IN KSA IS OVER?      latest  cumulative Saudi reports are of  ~558 MERS cases in KSA,   179 deaths ie ~7 new cases detected a day (none elsewhere) . Thus in the 3 weeks since 3 May, unverified reports mainly from middle east websites  are of about 101 new cases ie about 5 new cases a day, and 42 deaths in KSA   ie 2/day– ~40% mortality. The rate of new cases presenting and being detected is down, but with the incubation time-lag (5 to 14 days till illness if any),  assuming that all sick citizens are  promptly tested, the mortality rate will fall next week from its peak a week ago.  Tightening protective measures in the KSA  and no doubt  in all global air-hubs outside KSA are hopefully working- there has apparently not been another reported cases outside KSA the past week. 96% of all cases detected have been in KSA & UAE, with 90% of deaths from MERS being  in detected cases there. The lack of new cases reported elsewhere suggests that the global figures are now about 641 cases and 208 deaths ie about 32% mortality. .

22 May 2014 update:    in KSA   544 cases, 176 deaths  ie  so far 18 cases/million, 32% mortality;    UAE 7/million;    worldwide 661 cases,  207 deaths  ie 32% globally. But excluding KSA and UAE, the occurrence of MERS  in the rest of the world – including most of the >billion Muslims-  has been 50 cases ie Ian Mackay points out, the trend in new cases in KSA is downwards the past month. The common denominator in KSA appears to be  that especially city Muslim women there must be virtually totally  covered when outdoors in public view.. But as noted earlier in this column, repeated university studies there by their own specialists have shown that their people are especially vulnerable to vitamins D and C deficiency, so easily correctable , a testable hypothesis at trivial cost? This perhaps easily controllable plague  is surely an unintended consequence for  one of the most highly learned and religiously devout peoples in the world? Is the  epidemic growing solely  in the KSA because by strict custom, Saudi Arabian residents (and their pilgrim   visitors-who also are likely  ultraobservant)   have  to  cover up maximally, Dress to Kill? In the rest of the Arabian peninsula the MERS incidence rate is only a fraction? although the deathrate is similar.

19 May 2014 update:  KSA toll now  537 cases / 173 deaths  ie 31% mortality. The total there was inflated by 19 patients in the Jeddah  dialysis unit contracting MERS some time recently. It remains to be disclosed  how many of these cases were diabetic, were on vigorous vits C/D supplements, and died? The global figures are now 620 cases tested positive and 202 deaths.

17 May  2014 including a 3rd case (by direct contagion from a newly arrived traveler) in USA, there are  now  about 650 MERS cases reported  worldwide, 200 deaths ie 32%  fatalities;   14 new cases daily globally  the past 3 days;   KSA  529  cases   168 deaths (ie 11 new cases  a day; and 16  deaths the past 3 days). But 96% of all cases worldwide  to date  presented in the Arabian peninsula’s  80 million Arab population, and apparently   all 27 outside cases were exports from KSA or their immediate contacts. .. The Wiki entry  Tourism in KSA  states plainly :  “In December 2013, Saudi Arabia announced its intention to begin issuing tourist visas for the first time in its history.  Restrictions and security : Visas are only issued for business, relatives of Saudis, transit to a third country, and Muslim pilgrims; general tourism is not allowed.”   So effectively  in KSA cities  there are in public  only heavily-garbed  Muslims.  Apparently nownon-muslim tourists can visit the KSA in a group organized by an accredited agency”, obviously provided they conform to local religious norms. But “A limited tourist visa programme was cancelled in March 2014.[5]       Saudi Arabia does not currently issue a visa for tourist travel. Hence apparently the KSA population especially in the cities is  overwhelmingly  Muslims conforming to orthodox Wahhabi  Sunni outdoor   attire- although there are apparently  some 1 million christians (ie 1:30 of the population -presumably mostly professional/technician experts- in the big cities) in the KSA. Apparently there are over a million camels in the KSA,  (apparently nearly 25million worldwide) with a lifespan akin to humans. “Camels  come from neighboring Middle Eastern countries, in part, but also from countries in eastern Africa, including such already beleaguered places as Sudan and Somalia, Nigeria, Tunisia, Ethiopia.     Just now online, not scheduled for formal publishing until this summer, is a brand-new CDC report  finding widespread evidence of MERS-CoV in African dromedary camels too.” With the dromedary  numbers (at least 1 per 30 Saudi  citizens), camels’ huge stamina ie resistance to disease, including apparently the MERS virus they carry,  their cherished role including as pets, meat, transport, racingstock,  and supply of fresh warm milk  in KSA society; and  the reported low human vitamin D (and perhaps C) levels in the heavily-garbed city  citizens,  no wonder camels  are an ongoing source  of the hitherto unknown MERS coronavirus illness for immunodepleted citizens in KSA? whereas the camels themselves apparently suffer no more than a mild cold. A  respiratory virus infection in a temperate climate is usually easily thrown off with symptomatic Rx, supplements and plenty of fluids; but on the other hand, in  middle east desert  temperatures and in all-over robes, hyperthermia and dehydration from MERS  may more obvious cause of pneumonia and  (pre)renal failure- especially in a population with high rate of sickle cell, diabetic, overweight, cardiovascular and hypertensive disease. Average temperature  are about 29-330C ie mean peaks of 40C; with humidity  17% in Riyadh & Medina, but much higher in Jeddah;  intermediate in Mecca..

And “Middle Eastern countries import tens of thousands of camels from eastern Africa annually. Many Saudi camels are imported. Scientists don’t yet know where the MERS virus originated or how camels got it, but it has been found in African countries and as far away as Spain’s Canary Islands, where a tiny population of camels lives for the past 400 years .        ” Camels in the kingdom are like dairy cows, beef cows, racehorses, pulling horses, beloved Labradors, and living daily reminders of holy scripture, all in one. (Camels appear, honorably, in the Quran.)” As the latest report from Pulitzer Centre Prof Cynthia Gorney’s Nat Geographic account of MERS ends, “Fresh warm camels milk straight from the udder is “Very heavy, very sweet, very therapeutic” Ameer said, after I stopped shouting at him over the phone.  If I were still in Saudi Arabia at this moment, I told him, I would be smacking him upside the head.”  What likely gave Ameer his claimed  immunity? that he had been years in USA?, and like Arabian desert camel-keepers probably  lightly clothed and much in the sun- thus with good vitamin D levels?

A new report today from WHO chillingly details a party of at least 9  Umrah pilgrims since April 2014 who  from Jeddah visited Mecca and Medina  and then back via Jeddah to Amsterdam, Greece and USA with developing MERS – from the Jeddah sub-clade which has been identified in at least 30 cases there.. These linkages do not explain why the MERS outbreak has mushroomed solely in KSA residents – not in Muslim communities outside Arabia into which travelers flying home via Jeddah  have imported the virus. The co-factor may be that, having inhaled/ingested  the virus from human carriers in the KSA, these foreign travelers, often with co-morbidities, were also more vulnerable to the MERS virus because of their adherence to the same  all-over dress orthodoxy, and dietary vitamins D & C and perhaps zinc depletion  (with or without sickle cell trait) as has been reported prevalent in the KSA; and detailed with references below. A study is awaited of comparative skin shade,  diet and skin sunshine exposure (ie degree of conformance to strict Sharia covering) between Saudi Arabians of longterm Arab descent, and their relatives and  similarly conforming co-religionists in the distant diaspora Muslim overseas communities  that send Umrah and Hajj  pilgrims through Jeddah to Mecca and the other shrines. A current  wiki-islam website stresses the serious health hazards (both skeletal- rickets and osteoporosis – and across all system diseases including immune-infection- protection) of full-cover Islamic ie hijab dress through sunlight vitamin D deficiency, unless vigorous vitamin D supplement is taken.  It is no surprise that this is as much of a danger for hijab Muslims  in high-sunshine desert latitudes as in bleak low-sunshine cities far north.. This might explain why the latest WHO population statistics (perhaps 2011 ie before the MERS outbreak) show that – despite being perhaps  the richest  per-capita nation (from oil reserves)  in the world,- the KSA has expected survival age 5 years below that of UK, especially from combined (hypertension-diabetes-coronary heart- kidney ) disease rate of 375 in KSA vs eg 80 in UK. But even then, a different WHO website showed flu and pneumonia deathrate (before the MERS outbreak)  37 in hot, dry KSA ie 50% higher vs 23.7 in UK. and in about 2011, KSA had a mean population age of 20 years, with annual (agri-and seafood)  imports  ie dependence of US$17billion, due to its desert-limited agripotential; with predicted rapidly increasing urbanization .  It will cost pennies, and a few weeks’ followup of supplement dispensing to KSA citydwellers, (and incoming pilgrims before they leave their diaspora homes for the KSA),  of vigorous dose vitamins D3 +  C and a multisupplement including the other vitamins , magnesium, zinc,  iodine; and  fish oil and virgin coconut oil (ie a blanket antioxidant, antiinfection, antihypertensive  insulin-sensitizing umbrella supplement)  to confirm if the emerging epidemic of  MERS (let alone hypertension-heart-diabetes-kidney  disease)  in KSA  is significantly slowed, as  common infective and degenerative diseases  are here  in Cape Town, by such supplements. This simple prospective clinical monitoring of those receiving or not receiving  the swine flu vaccine in 2009 was universally recommended, but Authorities refused to enforce such simple monitoring, so there is  no clinical  evidence that the swine flu vaccine significantly reduced morbidity from the outbreak, which was globally statistically trivial except in the Mexican source outbreak. Similarly, there is no evidence that the spread of MERS-CoV  in KSA is epidemic considering that even in the four most densely populated cities – in the three abutting  midwest  provinces  – containing almost half the national population,  – the detected spread of MERS illness is still so low (except in the incubator hospitals). Even though camels are so widespread. it is intuitive that rural/desert citizens may take  both more fresh  (desert)  crops (ie vit C) and more  vit D- from both camel milk  and more sun exposure from  outdoor work with more skin exposure in such labourers. Some  pictures of camel attendants apparently in the KSA  on the internet  show bareheaded men in vests.  16 May 2014   the latest  KSA  stats reported are 515 cases, 160 deaths ie 30% mortality. Globally 621, deaths 189 14 May 2014  now ~592 cases reported in 20 countries – the latest in the Netherlands, and a 3rd case in USA;  with ~31% mortality (KSA 495 cases, 152 deaths ie 31%; with 20% asymptomatic). 12 May 2014:  USA reports a 2nd case arrives there. a 5th death with MERS has been reported in Jordan.  Saudi Arabia reports 8 new cases since yesterday, and 2 more deaths.   But  as expected, in the KSA eye of the storm , it appears that only contacts of  patients are being screened- at least 20% of patients who screen positive for the virus have remained well. So the morbidity and mortality% are in fact very skewed, they are apparently not screening the local population for carriers. The ~28% death rate refers only to deaths in the cohort that were afflicted  with MERS and their contacts.

11 May 2014  A new Reuters report today highlights the widespread intimate contact with camels in KSA. “Does the KSA want to control the uncontrollable?                                So far, the reported cases have all originated in Saudi Arabia or in the southeastern part of the Empty Quarter, in the UAE. There are no reports of those outside Saudi Arabia having transmitted the disease to others. the past week has seen another ~116cases  ~15 cases a day- reported in the Middle East, and another 34 deaths  there ie the total has reached ~578 cases (483 in KSA- Kingdom of Saudi Arabia) and ~163 deaths (142 in KSA). So  the death rate has fallen  to  <28% overall.  Lebanon and USA  become the 18th/19th countries to report a case of  a returning traveler.  But virtually all  identified cases originated in the KSA neighbourhood. The latest figures show that MERS originated and breeds exclusively in the Middle East- (cases per million ppm the past 2 years) in 16 ppm in KSA(483 cases total), 6ppm in UAE (53 total),    3.5 ppm in Qatar(7  total)  and  1ppm or less  in Jordan (9 total- the first reported cases, in April 2012)) or elsewhere. Apart from the frequency of camels, and the high prevalence of deficiency of vitamin D and possibly vitamin C reported below, ethnic culture may play a major role:  In KSA, Qatar and UAE the great majority of citizens are Wahhabi Sunni muslims. By contrast, Yemen is only 65% Sunni, but  Oman is distinctly different Sharia culture. Iraq and Iran are predominantly Shia culture.

Jordan on the other hand is a unique  Hashemite culture although also  70% Sunni;  so contrary to the Wahhabi countries,  “ Jordan is one of the most liberal countries in the Middle East, with a secular government“. So the increasing prevalence of MERS in the Wahhabi Arabian peninsula peoples relates perhaps  to the likely cluster of predisposing factors:   well-covered male and especially female orthodox attire, if not also higher prevalence of sickle cell trait, and diet,  which is associated with deficiency of vits D, C, A and E as referenced below. Feminist Muslim websites may correctly argue that Hijab does not cause vitamin D deficiency;  but it likely contributes significantly to it’s spread via lowered vitamin D production in skin – with orthodox Muslim women arguing that such women can arrange private sunlight skin exposure. This trend to vitamin D deficiency from low oral   and sunlight-mediated  vitamin D is incidentally mirrored in  new studies:. :                                                            from  USA – The Vitamin D status of Prison Inmates– which confirmed that, on a ‘sufficient’  diet including vitamin D intake,  the higher the security isolation of inmates (and therefore least sun-exposed), the lower the vitamin D status- especially in the darkest-skinned inmates; from Israel   Effect of different dress style on vitamin D level in healthy young Orthodox and ultraOrthodox students in Israel; and in southern Italian nuns.

So vit D deficiency in MERS  may be like  in AIDS:  Vitamin D Deficiency in HIV: A Shadow on Long-Term Management)? (2014, London UK).  But vigorous vitamin D charge – by sunshine and especially vit D3 supplement- as an immune and anabolic booster is one of the safest and cheapest preventions of all disease that there is. With the Ramadan Hajj to the KSA this year only 6 weeks  away, intended pilgrims need to top up their vitamin D3 levels and multivites vigorously now, to boost both their infection resistance and improve control of all major diseases they have;  and take plenty of vitamin C with them.  So should  their communities, contacts  here as pilgrims return from the Hajj. SUNSHINE AND ORANGES: ANTIBIOTICs VITAMINS C AND  D like vitamin CVitamin D is hardly a new anti-infective agent as an Israeli study (Borella ea 2014) now confirms, since sunshine sanatoria were  the only effective treatment of tuberculosis in the pre-antibiotic era even after WW2; and ” An association has been established between low levels of vitamin D and upper respiratory and enteric infections, pneumonia, otitis media, Clostridium infections, vaginosis, urinary tract infections, sepsis, influenza, dengue, hepatitis B, hepatitis C, and HIV infections“. Especially in this post-antibiotic age of rampant antibiotic resistance. Sunshine and Oranges – Empty Cradles-  is  ironically,  the account of Britain’s infamous ruthless  export- banishment to the Colonies -from the early to post WW2  20th C   of thousands of surplus children of poor or orphaned families. Shades of the forced transport of ‘felons’ to Devil’s Island and the British outposts of previous centuries.  Usually clad in scanty rags, in Australia  they certainly   had plenty of sunshine ie vitamin D , and  the abundant local oranges (vitamin C);  but like their surviving mothers, much grief and poverty – while from lack of these same nutrients, their kith and kin back in UK  were ailing with infections and rickets . .

3  May 2014  four months later:  MERS RESURGENCE: NOT A PANDEMIC BUT A DEFICIENCY SYNDROME? more precautions needed:  With the recent flareup of MERS Middle Eastern Respiratory Syndrome in the Gulf States, the number of reported cases since New year has more than doubled to 457 ie to >24 cases a week there, but still only in residents/ travelers from/through the Middle East hub, and their contacts;   in 17 countries including Europe, Egypt, Malaysia,  Philippines and now a traveler from Riyadh to USA.  The death toll has reached 133/457    ie the death rate  has  fallen steeply   from 42% last December to 29% overall, understandably as more cases are detected by screening in the source, the Kingdom of Saudi Arabia KSA.   Wiki   and Reuters seem to give  the most update  (if not WHO-confirmed) stats. So the evidence so far is that, while camels are endemic carriers there,  most  recent sick cases have apparently been been traceable  human to human transmission – apparently all among Muslims, and in the malnourished or chronically ill older, and  health workers as in the case just reported in USA.      So there is no apparent spread by other vectors eg bird and farmyard swine as in the case of influenza. Since the reports available indicate that the MERS virus is dangerous only in those already malnourished or with serious other systemic disease, it is like flu-  pretty harmless in the well adequately nourished and housed. While frequent flyers are generally well off and well nourished, the same cannot be said for those in virtual ghetto  slavery all over the world, eg migrant labourers  working on contract  in the Gulf States, who have apparently been among the latest victims . So as with the overblown Swine Flu non-pandemic of 2009, there is no good evidence to label MERS  a deadly epidemic, it in fact seems to have low cross-infectivity compared to say influenza which spreads like wildfire- but with no more morbidity (except in Muslims?) than the common cold corona viruses.

WHY IS MERS  LIMITED OVERWHELMINGLY TO AND SPREADING ONLY IN THE KSA and UAE?  is it a unique genetic trait of Saudis?  or is it micromalnutrition unique to this  ultra-orthodox Muslim nation with unique almost total skin coverup outdoors? why was there no outbreak of MERS in the millions of pilgrims who did the Hadj to the KSA last year?   the KSA is 100% muslim, whereas the UAE only 76%, with far more foreigners working and living there. It is common cause that peoples who keep well covered during daylight hours – as ultraobservant Muslim (and ultra-orthodox Jewish)  women and  men do, have much lower vitamin D levels. Those on restricted diets are also more prone to malnutrition including vit D deficiency, especially if low in dairy products. Common sense perhaps explains  why Saudis – in the heart of Islam (Mecca, Riyadh, Jeddah, Tobuk) have low vitamin D and likely also low vitamin C and zinc levels, and thus more infections. Moderate to severe vitamin D deficiency was reported prevalent  last year in Saudis by Al-Daghri,  Sabico  ea  from King Saud University Riyadh- where Hasanato in 2006 reported low vitamins A, C and E and zinc levels in severe sickle cell disease. El-Hazmi ea  from the Saudi College of Medicine also in 2011 reported that Saudi Arabia and Bahrain have the highest prevalence of sickle cell genes in the Middle East,  at up to 18%. Bahrain has just opened a sickle cell hospital, but Bahrain has the tiniest population (1.3million) of the Gulf States although the highest population density, compared to the 38million of the KSA plus the UAE which have had over 90% of MERS cases. Most if not all the camels in Bahrain are in a zoo; whereas in the KSA camels are a favourite if not sacred possession and listed first as the  domestic animal. So the absence of MERS in Bahrain is unsurprising.

The UAE on the other hand also has many camels as entertainment if not also for travel – with 5000 camels entered in a beauty contest there alone.. So, despite long days ie much sunshine exposure in Arabia, low  fresh water availability likely reduces hygiene  (washing and oral hydration) capacity for the masses let alone camels.  And the well-covered dress code, and low availability of private sun-exposed balconies and courtyards  (unlike apparently more liberal Muslim countries) mean that the Saudi masses do not have the opportunity to get much-needed sun exposure to even the face, neck and limbs let alone the torso.

        Hence Saudis have as obvious  major risk factors for MERS  -not just the teeming MERS reservoir in their valued  camels (also a staple   milk supply), but more importantly endemic deficiency of vitamins C, D (and perhaps E, zinc) and water compared to relatively less clothed populations in other  hot but also better water-supplied  countries that also do not carry much sickle cell disease.

Camel meat is apparently no longer a staple in the KSA where staples now include Bread, hummus, rice, and  Tabbouleha “salad” generally made of parsley, bulgur, tomatoes, garlic, and lemon; Kapsa: the national dish is chicken and rice with vegetables; and Kebab:  a base of roasted lamb or chicken and vegetables in pita bread. There seems  little vitamin D in that varied diet, especially not pita bread or rice.

      The only good unfortified and unprocessed food sources of vitamin D are apparently oily fish,  liver, mushrooms, and (if fortified),  egg yolk and dairy products ; or else vitamin D3 supplements. ..

Finally, it is common cause from published studies and our local experience that infections eg HI, TB,  influenza,  herpes  and the common (Corona virus) cold are easily treated and prevented by vigorous safe intake of vits C & D combined with the other multivites, zinc, iodine, iron and selenium. In advanced infection cases of eg HIV and TB (in trials  from Central Africa and Canada), combining even modest doses of just 2 or 3 of these supplements with appropriate antivirals and antibiotics reduced dreadful morbidity and mortality by two-thirds. NATURAL PREVENTION/TREATMENT: with the theoretical double peril of influenza and MERS-   (ie as with the looming  Influenza A gastro-/respiratory season in the southern hemisphere),  with no proven  vaccines or antivirals reported or likely, those in contact with Middle East travelers- or any infection eg flu  outbreak- are again reminded to boost their immunity  and global health with safe effective lowcost NUTRITIONAL ANTIINFECTIVE supplements: 1.VITAMIN D3 CHOLECALCIFEROL 2500-4000iu/kg/month  (not the weak  vit D2 ergocalciferol  falsely labelled  “Strong” Calciferol tabs) most simply taken as a few scoops ie 50 000 to 250 000iu of vit D3 powder/MONTH at all ages (AND IDEALLY target BLOOD- LEVEL 80-100ng/ml depending on overall illhealth state. IT IS VIT D3 THAT IS STRONG CALCIFEROL, NOT VIT D2, since experts report that vit D3 is apparently four times more potent than D2. 2. MULTIVITES with zinc selenium and iodine (and iron for likely deficient eg kids, young women), but  especially 3.  buffered VITAMIN C ASCORBATE  at least 3gm/d orally ( if not with bad infection symptoms – 10 or >30gms / day if not ivi)  at trivial cost as powder;  to tolerance; 4. with eg  ecchinacea, melatonin, garlic, colloidal silver, sutherlandia and whatever other antiviral available locally. Since flu and colds disrupt both sleep and outdoor activity, nothing makes as much sense as co-supplementing both of the day and night hormones melatonin and vitamin D; as well as the other sunshine vitamin- ascorbic acid (solar-produced in abundance in  eg fruit) – to improve both sleep, rest and immunity. For small kids/infants the vitamins and minerals can simply be taken as powder in liquid ie in feeding bottle or a  glass. It is increasingly notorious how depleted modern breastfeeding mothers (on the industrial polluted fructose-sucrose-  aspartame PUFA-antibiotic-hormone-glyophos- GMO laden  food chain now prevalent)  and baby formulae  (unlike colostrum from pasture-fed eg New Zealand dairies) are in such lifesaving  immune and anabolic anticancer  boosters.

Ironically,  recently  Prof Zahid Naeem ea from the KSA Qassim University publicised in their university International Jnl of Health Science   Vitamin D Deficiency- An Ignored Epidemic in 2010  and 2012  , with prevalence there of up to 80% in the KSA despite the abundant sunshine, thus urging vitamin D supplementation. . But such simple prevention – of all disease but especially wished-for megaprofit  pandemics like flu and HIV-  is anathema to the multinational Big Pharma and their lobbyists in the global Disease Industry, which employs millions worldwide and generates trillions in income for government and corporates. Prevention does not pay. Simple prevention suits no-one working in the disease  and drug and hospital industry since it makes most health workers especially doctors and administrators and hospital  largely redundant. It seems that public health officials choose to go on ignoring the deficiency epidemic even in the KSA- unlike Dubai, there is no website of the KSA Govt promoting vitamin D supplementation.  The solution is too cheap – and embarrassingly simple.  An anonymous blogger details the numerous reasons for endemic vitamin D deficiency in especially the Gulf States.. at least the Dubai Govt publicises the deficiency, and supplementation. Is it irony, or an indictment of the prevailing world-wide largely male-dominated -subservient female culture,   that already back in 2001, there were strong warnings about Niqabs and Burqas as Impediments to Health? already in 2012, dairies in the UAE were fortifying milk with vitamin D; and in 2001 academics published a study showing the many reasons for prevalent vitamin D deficiency in the KSA. and Prof Mike Holick  in 2010 published an authoritative review  The Vitamin D Deficiency Pandemic: a Forgotten Hormone Important for Health urging vigorous vitamin D supplementation universally. As detailed elsewhere in this column last year,  the prophet of vitamin D and melatonin  the late Prof Walter Stumpf must be shaking his head repeatedly along with  the late Prof Linus Pauling, about the neglect of authorities  to promote and distribute vigorous supplements of vitamin C and D3 to the afflicted Arabian peoples let alone worldwide. But then we need to be reminded of the infamous Vitamin Murders, how Prof Sir Jack Drummond was mysteriously murdered with his family on holiday in France in 1952, when he and Linus Pauling were  the  leading vitamin discoverers and promoters  of the 20th century (as Walter Stumpf was of melatonin and vitamin D). The Big Pharma Disease Industry combined with the might of the FBI  and the FD  could never shut Pauling up;  but by whom and why the Drummonds were murdered remains unsolved, thus fertile conspiracy theory. Reading Drummond’s papers on the internet, one can understand why the burgeoning patent drug industry then as now hated natural lowcost unpatentable remedies, unbeatable natural safe  antiinfective agents like vits C and D and iodine – each almost universal panaceas. . .

This universal truth about industry suppressing  natural remedies  is the Semmelweis Paradox, that had the leading obstetrician of his day murdered in his prime by his jealous rivals.

27 Dec 2013  the outbreak not over:  9 new cases;   ie overall deathrate 42%, but past 2 weeks  4.5 cases a week just from the KSA..  :  Since April 2012, the European Centre reports  175 laboratory-confirmed cases, including 73 deaths, of acute respiratory disease caused by Middle East respiratory syndrome coronavirus (MERS-CoV), have been reported by national health authorities.  27 December,  Saudi Arabia confirmed nine cases (five asymptomatic healthcare workers and four patients suffering from chronic disease, two of whom had died).  24 Dec 2013 the score now stands at 166  (163 at 16 Dec)  cases and 71 fatalities- 42% –   in 18  months since the first identified case in June 2012; ie per week – 2  new cases and 1 fatality .  No pandemic. No outbreak. Considering the duration of the awareness  of the new virus in humans- apparently from bats/camels/swine,  even after 18 months of millions of pilgrims visiting the Middle East, and far more foreign travelers flying through those hubs, and intensive surveillance on those routes east and west,   the morbidity and mortality have been negligible with only a handful of perhaps related deaths in frail patients. Whether as with seasonal avian  ie H1N1 flu from China to the West and south there will be a flareup of MERS-CoV cases  in the pending winter from now on  in the Middle East, remains to be seen..

12 November 2013   Considering that the Hajj has just ended with millions of pilgrims returning home,  and vast numbers of multinational passengers transit through the Middle East hubs, its reassuring  that (depending on which reports are duplicates and delayed) only 3 or 5  tested positive cases and 1 or 2  deaths have been reported the past week:    especially since only serious flu-like cases are likely to be tested- but more so in the affluent who can afford to fly.   So far no reports of MERS-CoV case are apparent in South Africa, although flu-like illness remains  common here. Perhaps more people are heeding warnings to take multivites plus zinc plus vigorous vits C and D. The ECDC    and  OSAP  and NowNews  and GlobalAlert report   As of  11 November 2013, there have been  at least 154 laboratory confirmed cases of MERS  CoV worldwide, including 65 deaths ie 42% in TESTED cases. All cases have either occurred in the Middle East or have had direct links to a primary case infected in the Middle East.        Saudi Arabia has reported  at least 125 symptomatic and asymptomatic cases including 53 deaths  Jordan two cases both of whom died   United Arab Emirates five cases, including one fatality Qatar five cases, including two deaths  and  Oman one case who has  just died.       Thirteen cases have been reported from outside the Middle East: inthe UK (4), France (2), Tunisia (3), Germany(2), Italy (1) and Spain (1). 31 Oct 2013 with the Hajj over, the latest score is 149 cases and 63 deaths ie 42%. http://www.who.int/csr/don/2013_10_31/en/index.html ie 5 new cases a week from the region, 30% deaths. http://gmggranger.wordpress.com/2013/10/29/quikstats-mers-cov-in-the-arabian-peninsula-nov-2013/ 17 Oct 2013 with the Hajj in full swing, the latest tally is apparently 139 cases and 60 deaths.  So thats only 1 case  reported a week the past 4 weeks, and no deaths in that time.  Promising news, although we continue to see bad viral-like  respiratory-gastro infections in adults locally with the volatile weather.

20 Sept 2013 with below a month to go to the Hajj, the latest Quickstats are 135 cases confirmed, and 60 deaths ie 44% mortality- all new cases and deaths apparently in  KSA and the Gulf States. Thus in the past 7 weeks,  41 new cases have been reported ie 6  a week, all in the Gulf  States; with unaltered  mortality  (44%) apparently restricted to the chronically frail. This as the drastically variable  Cape Town weather alternates sunshine joy and freezing wet  snow or hail, with high prevalence of both respiratory and gastroenteritis attacks, sometimes with protracted debilitating bronchitis; how much of this is local seasonal colds- coronavirus– or  flu, orMERS-CoV,  or  the explosive Norwalk virus, is speculative and academic. Basically So What since management is symptomatic, and vigilant prevention  crucially effective with hygiene, home rest and multivites but especially highdose vits D3 up to 10 000 (100iu/kg)  iu/day or weekly equivalent plus  buffered vit C up to tolerance >100mg/kg/day, zinc, selenium and for the malnourished, iron; perhaps safe plant  immune boosters like sutherlandia, garlic etc; and avoidance of smoking, sugar and the likes-  boozing and sweetened soft drinks (fructose, aspartame,sucralose).

11 August 2013  OUT OF AFRICA?  no new cases of MERS-CoV have been reported the past week; but while camels (in Oman) are now also suspect hosts/ transmitters in the M E,  there is some evidence that the MERS virus has the closest virus match yet found to bat CoV  in South Africa. As a precaution, with upgrading of shrines in Mecca, KSA is actively reducing  overcrowding by Hajj visitors by 20%, and warning the frail  and elderly not to go this year. With the prevalent bad winter respiratory and gastroenteritis  infections at least around densely populated and polluted Gauteng and  KZ-Natal,  and especially the floral mountain kingdom of greater Cape Town-   all are encouraged to take vigorous doses of vitamins D3 and Superenhanced vitamin C with a broad multimineral-multivite –  extra vits A, E, B &   coQ10;  the minerals zinc,  selenium, iodine, colloidal  silver, (and iron in the young commonly at risk of deficiency);  probiotics ;  rooibos or buchu or green honey and lemon tea,  sutherlandia;  licorice, St John’s wort, garlic,  echinacea, olive leaf  etc;   including sniffing vitamin C ; and  if snotty rhinitis/sinus/bronchitis symptoms,  steaming with eucalyptus etc.. And during acute attacks especially of respiratory and gastro attacks,  avoid sugar,  fat,  dairy and wheat intake.

2 August 2013  The Hajj to Mecca this year is  in the third week of October.  While over 15 million (of the world’s ~1.5billion) Muslims visit Mecca – Umrah- annually, some 3 million pilgrims worldwide make the seasonal Hajj visit trip, with pro rata from South Africa  only 2000 (of our ~2.5million) apparently the quota of pilgrims allowed this year   by Saudi Arabia . But increasing numbers of frequent flyers of all nationalities and races to and from South Africa – Europe fly via the Gulf States  Emirates airline, if not commuting to work and visit family there – including professional sports teams for tournaments… So this week’s flood of warning bulletins  on the Gulf State respiratory infection outbreak are cause for urgent caution and prevention, perhaps grim news for those who fly that ME route, and their families and close associates and neighbourhoods. The 49% deathrate reported in the now 94 cases- 3 more reported  1 August  from KSA- so far from the MERS-CoV Corona Virus MiddleEast Respiratory Syndrome outbreak is alarming, that has spread the past 10 months  from the Kingdom of Saudi Arabia KSA  and  the Gulf States  to Tunisia, Europe – France, Germany, Italy-  and UK . It is now being recognized as distinct not just from the common cold coronavirus but also from the Chinese Severe Acute SARS-CoV virus outbreak since 2003, of which over 8000 cases have been recognized , but the latter virus having a fatality rate of only <10%; and the current violent but selflimited Norwalk virus  gastroenteritis (explosive vomiting and diarrhoea for 1 -3days;  (fatality rate <0.1%) raging in UK,  it recently is the commonest cause of foodborne infection in USA  .

No clinically effective vaccine or synthetic drug treatment has yet been found for these coronaviruses . The same lack of specific antiviral therapy applies against gastroenteritis viruses and influenza, but the mythical 2009 swine flu ‘pandemic’ was even milder (than some seasonal flu outbreaks) with a proven mortality rate far below 1% considering how rapidly far and widely it spread. The reservoir if any of MERS-CoV may  be cave bats, (and, ominously, perhaps swine – c/f the 2009 swine flu ‘pandemic’ that wasnt; shades of the deadly Nipah virus outbreak of 1999 – from bats to pigs to man).. But the fact that MERS-Co is spread human to human, and mainly men ,  has been attributed perhaps to women in strict sharia society being well veiled and thus shielded from inhaling (and transmitting) the air-born virus, never mind womens’ generally stronger immune systems and hygiene, self-care. So beware   all those in close contact with recent air-travelers through the ME states and surrounding subcontinent airports – never mind the S-E-Asia airhubs of Hong Kong and Singapore: it maybe  only a matter of weeks before cases occur on the other continents especially in city dwellers, public transport commuters, factory and office workers; and who knows, perhaps where bats and swine cohabit close to cities, as around South Africa.. .. Its cold comfort that the latest report  yesterday and today,  note that this stage is perhaps like SARS in 2002 and swine flu in 2009, the ‘bottom of the iceberg’, with only severe cases being admitted, tested, reported, in already chronically ill frail patients; especially diabetics and renal failure – to which older Muslims are particularly prone; while the virus spreads silently, mildly if not harmlessly  in the well majority, as in two young well  women health workers in contact with a chronically ill elderly female case in Riyadh, KSA … ANTI-INFECTIVE PROTECTANTS and advice are available from the Natural Remedies Centre, 15 Grove Bldg, Grove Ave, Claremont, Cape Town ph 002721-6831465 or -6717415: Fortunately  all Health Shops  are well stocked with the many  almost 100% protectants against serious infections including fungi bacteria and viruses – colds (ie corona-) and flu’-virus (let alone against all others) afforded by the basket of locally available (although mostly imported)  natural lowcost evidence-based  nutritionals – supplements  the past decades: safe  hefty combinations of a number of immune-boosting  vitamins, minerals and foods, herbs. This septuagenarian author has, touch wood, on this combination- increased at occasional  times of suspected colds-fever- , despite great stress, and flu ‘pandemics’, and avoiding vaccinations,     not had a bad infection lasting a day in the past 5 years despite working in the highest risk  poor townships and acute hospital clinics with rampant HIV – multiresistant TB cases .

4 August 2015 VITAMIN D: FOR INDOOR TYPES, HOW MUCH eg 50 000iu/d IS ENOUGH, AND SAFE? & 2million iu loading dose is not toxic for adults. Especially for infants, acute illness- ICU, INFECTIONS:

 VITAMIN D REVIEW: WHAT DOSE IS ENOUGH ?   INSUFFICIENCY vs DEFICIENCY, VIT D RESISTANCE?    COMBINATION OF ANABOLICS?     ACUTE LOADING DOSE eg FOR INFECTION, ICU, BURNS, BRONCHIOLITIS?     SAFE vs OVERDOSE-TOXICITY DOSE & LEVELS?  VIT D ALLERGY?

neil.burman@gmail.com

see previous vit D updates:  at  23 Mar 2015 womens’ day: the crucial role of vitamin D as HRT in reducing all major diseases . Salute Dr Walter Stumpf

and    https://healthspanlife.wordpress.com/2009/10/29/is-there-a-vitamin-d3-conspiracy-of-suppression/

and 17 JUNE 2015 VITAMIN D DEFICIENCY VIRUS EPIDEMICS.

PREFACE WARNING: nb black italics are abbreviated quotes; for the link click on blue italics  eg McKenna ea.            NB conclusions depend, are based on, apparently reliable formal  randomized controlled RCTs trials  and team experiences, (but RCTs, metaanalysis, reviews and case reports   are also notoriously  vulnerable to vested interests of authors and sponsors, statistical errors, omission of inconvenient results, even subtle blatant fraud and fabrication;  to small numbers, heuristics and bias   – confusing causality, type 2 statistical errors ie sheer random chance; per  eg per Nobel prizewinner – the American  Daniel Kahneman : Thinking, Fast and Slow: New York 2011; the Briton   Oliver  Gillie 2014; Vit D, Sunlight, mortality, causality  and The Scots   Paradox, the Swiss Paradox;  the Flu, MERS, AIDs-TB-ebola epidemics: Can Sun Exposure, or  Lack of it, Explain Major Paradoxes in Epidemiology; https://www.linkedin.com/in/olivergillie;biography); the Semmelweis Paradox;  the current epidemics in Central and South Africa, Saudi Arabia, South Korea, cities & refugee camp  ghettos, 1918-19 et seq;  the German Gerd Gigenzer  http://www.gocognitive.net/interviews/gerd-gigerenzer-decision-making.

4 August 2015 update: why do new trials/ reviews keep referring to mediocre dose vitamin D3 as high dose?    Karen Hansen’s  Univ Wisconsin  trial compared placebo, with baseline  vit D3  24000iu /month and as high dose 5 fold more ie  124000iu/month- finding no significant benefits. BUT  124000iu/month is still only about 4000iu/day, which on average increases 25OH Vit D3 only by about 40ng/ml. This is hardly high dose when vigorous levels are at least double this ie close to 100ng/ml; and vigorous safe dose long term is around 50 000iu/day ; with up to 150 000iu/day, up to above 250ng/ml blood level,  having been taken for decades, or single dose of 2million units,  without toxicity... Of course safety depends on adequate water, magnesium and vit K2 intake, and not adding  calcium supplements since average city diet is low in magnesium, iodine  and vit K2, not calcium or toxic fluoride or bromine. 

                      2015 Aug 3  JAMA Intern Med. . Treatment of Vitamin D Insufficiency in Postmenopausal Women: A Randomized Clinical Trial. Hansen, Marvdashti ea http://www.ncbi.nlm.nih.gov/pubmed/26237520 . Experts debate optimal 25-hydroxyvitamin D (25[OH]D) levels for musculoskeletal health. Objective  randomized, double-blind, placebo-controlled clinical trial was conducted at a single center in Univ Wisconsin   from  2010, completed 2014. A total of 230 postmenopausal women 75 years or younger with baseline 25(OH)D levels of 14 through 27 ng/mL and no osteoporosis were studied.  Interventions: Three arms included daily white and twice monthly yellow placebo (n=76), daily 800 IU vitamin D3 and twice monthly yellow placebo (n=75), and daily white placebo and twice monthly 50,000 IU vitamin D3 (n=79). The high-dose vitamin D regimen achieved and maintained 25(OH)D levels ≥30 ng/mL. Main  Results:  After baseline absorption was controlled for, calcium absorption increased 1% (10 mg/d) in the high-dose arm but decreased 2% in the low-dose arm (P = .005 vs high-dose arm) and 1.3% in the placebo arm (P = .03 vs high-dose arm). We found no between-arm changes in bone mineral density, trabecular bone score, muscle mass, and Timed Up and Go or five sit-to-stand test scores.  High-dose cholecalciferol therapy increased calcium absorption, but the effect was small and did not translate into beneficial effects on bone mineral density, muscle function, muscle mass, or falls. We found no data to support experts’ recommendations to maintain serum 25(OH)D levels of 30 ng/mL or higher in postmenopausal women. Instead, we found that low- and high-dose cholecalciferol were equivalent to placebo in their effects on bone and muscle outcomes in this cohort of postmenopausal women with 25(OH)D levels less than 30 ng/mL.
26 JULY 2015 UPDATE:
1,   Calcium supplements are no longer recommended for adults:  they promote vascular calcification and worse.

J Intern Med. 2015 Jul 14. Calcium supplements: benefits and risks. Reid , Bristow , Bolland .University of Auckland, New Zealand. Calcium is an essential element in the diet, but Calcium Study demonstrates no relationship between dietary calcium intake and rate of bone loss over 5 years in healthy older women with intakes varying from <400 to >1500 mg day. Thus, supplements are not needed within this range of intakes to compensate for a demonstrable dietary deficiency, but might be acting as weak anti-resorptive agents via effects on parathyroid hormone and calcitonin.  As a result, anti-fracture efficacy remains unproven, with no evidence to support hip fracture prevention (other than in a cohort with severe vitamin D deficiency) and total fracture numbers are reduced by 0-10%, depending on which meta-analysis is considered. Five recent large studies have failed to demonstrate fracture prevention in their primary analyses. This must be balanced against an increase in gastrointestinal side effects (including a doubling of hospital admissions for these problems), a 17% increase in renal calculi and a 20-40% increase in risk of myocardial infarction. Each of these adverse events alone neutralizes any possible benefit in fracture prevention. Thus, calcium supplements appear to have a negative risk-benefit effect, and so should not be used routinely in the prevention or treatment of osteoporosis.
        Rather it is vits D3, C,  K2 ;  and magnesia supps that are recommended for multisystem benefits-  magnesia especially for prevention of common renal stones- since the classic paper from Harvard  Am J Clin Nutr. 1967;20:393-9. Effect of daily 200mg MgO   and 10mg vitamin B6   administration to patients with recurring calcium oxalate kidney stones. Gershoff & Prien.
2. for preventing eg calcium stones and mortality etc, vit D3 in high enough dose to switch off hyperparathyroidism. eg Clin Nutr. 2015 Mar 24.    Vitamin D3 supplementation and body composition in persons with obesity and type 2 diabetes in the UAE Sadiya , Abusnana ea The study was executed in 3 phases in two arms vitamin D arm (n = 45) and placebo arm (n = 42); in Phase 1 the vitamin D arm received 6000 IU vitamin D3/day (3 months) followed by Phase 2 with 3000 IU vitamin D3/day. During follow up (phase 3) both the arms were un-blinded and supplemented with 2200 IU vitamin D3/day for another 6 months . On supplementation no significant changes in anthropometric dimensions was observed. S-25(OH) D peaked in phase 1 (77.2 ± 30.1 vs 28.5 ± 9.2, p = 0.003) followed by a decrease in phase 2 (62.3 ± 20.8, p = 0.006) paralleled by a decrease in parathyroid hormone in phase 2 (5.9 ± 2.4 vs 4.5 ± 1.8, p < 0.01) compared to baseline in vitamin D group. Supplementation was safe, improved s- 25 (OH)D also reducing the incidence of eucalcemic parathyroid hormone elevation.
      Crit Care Med. 2015 Jul 16.   A Randomized Study of a Single Dose of Intramuscular Cholecalciferol in Critically Ill Adults.  Nair, Center ea   Univ Sydney & Brisbane, Australia.  LMU, Munich, Germany.    To determine the effect of two doses of intramuscular cholecalciferol on serial serum 25-hydroxy-vitamin-D levels and on pharmacodynamics endpoints.Prospective randomized interventional study.
Fifty critically ill adults with the systemic inflammatory response syndrome.Patients were randomly allocated to receive a single intramuscular dose of either 150,000 IU (0.15 mU) or 300,000 IU (0.3 mU). Secondary hyperparathyroidism was manifested in 28% of patients at baseline. Parathyroid hormone levels decreased over the study period with patients achieving vitamin D sufficiency at day 7 having significantly lower parathyroid hormone levels (p < 0.01).  Although in-hospital mortality rate did not differ between the groups, patients who did not mount a parathyroid hormone response to vitamin D deficiency had a higher mortality (35% vs 12%; p = 0.05). No significant adverse effects were observed.
     3  universal vitamin D3 deficiency:   our local population, as in virtually all populations worldwide who no longer work and live bare in the sun and eat plenty of raw fish(eg unfiltered cod liver) (oil) have average blood 25 OH vit D levels at or below 20ng/ml, whereas it is  incontestable that all diseases decline steadily as this marker vit D3 level is elevated by sunshine to the probable maximum natural achievable level around 40ng/ml- and with vigorous supplements eg 50 000iu/wk  up to around 80ng/ml, but in sickness to around >100ng/ml.
 4.    But the vit D overdose literature shows that while the highest adult vit D3 doses that have been prescribed are about 640 000iu as monthly dose (Salhuddin N ea , Karachi Pakistan 2013- with 40% improvement in TB recovery after only 2 months compared to TB pts given antiTB Rx alone), and 40 000iu/day in South America for months  for serious pemphigus and albinism. The Pakistan Endocrine Society is a pioneer professional group in endorsing vigorous vit D3 dosing.
But the threshold for toxicity- hypervitaminosis D– seems to be above 2million units single dose in nonagenarians (Netherlands 2 pts) or 88 000iu/day longterm (Canada); and blood 25OHvit D above 250 – 500ng/ml. one 70yr old women was reported to present with Hypervit D only after 10 years  taking 100 000ium/d ie over ~300million iu.. Another women was reportedly  unharmed after 5  times that ie @ 150 000iu/day ,  1.5 billion vit D2 iu over 28yrs –Stephenson & Peiris 2009.
small Subcontinent people–  Pakistanis, Indians etc may be more prone to overdose with vit D, often from massive doses given by injection weekly ie no chance of reducing absorption plateauing as oral overdose increases, as normally happens.
 
VIT D2 VS D3:  note that as one of the most backward Govts in the world, RSA   STATE  authorities- at least in W Cape eg state hospitals and  day hospitals- still distribute and promote vit D2 for osteoporosis, altho these tabs falsely labelled Strong Calciferol are in fact fraudulently labelled,  only their manufacturer website Lennons-Aspen reveals that they are in fact ergocalciferol vit D2, which experts have long condemned as only about 1/4 the strength of vit D3, and which D2 in two studies actually worsens not improves rheumatoid arthritis. This in contrast to the all-disease beneficial  anabolic steroid vit D3 which wholesales in bulk at around R200/kg.a different independent website eg http://www.ndrugs.com/?s=lennon-strong%20calciferol does reveal that Strong calciferol is in fact D2, but not that it is a xenohormone manufactured only by yeasts, not animals; and that it elevates 25OH vit D2– not D3- in our blood, thus blocking both our D3 receptors and formation.   Wiki does detail that it is made only by lichen, mushrooms and alphalpha- but not by any animals.
Already in 2006 Houghton and Veith (Univ Toronto Canada) published The Case Against vitamin D2.. Vitamin D2, or ergocalciferol, should not be regarded as a nutrient suitable for supplementation or fortification… no successful clinical trials to date have shown that vitamin D2 prevents fractures..The poorer stability of and greater impurities in vitamin D2 powders may also lead to a higher risk of toxicity than that associated with the vitamin D3 metabolites. However, it is more likely that the weaker affinity of vitamin D2 metabolites to DBP produces higher and more biologically available proportions of free 25(OH)D2 and 1,25-(OH)2D2 and may thus be responsible for the greater risk of D2 toxicity .  Taken together, the most plausible explanations for the greater bioefficacy of vitamin D3 are conceivably due to the higher affinities of vitamin D3 and its metabolites than vitamin D2 for hepatic 25-hydroxylase, DBP, and VDR and because vitamin D3 is not directly metabolized to 24(OH)D as is vitamin D2.”D2may be safe in mega-overdose, but this  2009 abstract from a Tennessee Veterans’ Admin unit  begs the question of whether the D2 tablets were indeed genuine vitamin D, of any benefit to the patient? who apparently consumed over a billion iu of vit D2 in  half a lifetime – at least 20 times the aggressive dose of 50 000iu/week. :

South Med J. 2009 Jul;102:765-8..  The lack of vitamin D toxicity with megadose of daily ergocalciferol (D2) therapy: a case report and literature review.   Stephenson & Peiris .The maximum daily dose of vitamin D currently recommended is 2000 IU. Ergocalciferol (D2) 50,000 IU orally weekly for 8-12 weeks is often used to treat vitamin D deficient patients (25(OH) vitamin D <20 ng/mL). The lack of vitamin D toxicity after massive doses of ergocalciferol has yet to be reported in the literature. We report a case of a 56-year-old woman who received supratherapeutic doses of ergocalciferol (150,000 IU orally daily) for 28 years without toxicity. We discuss the possible mechanisms which may account for a lack of toxicity despite intake of massive daily doses of ergocalciferol in this patient.
                    1 July 2015 update:  The  2008  report from Kimball & Veith, Toronto concludes:  The lowest observed adverse effect level for vitamin D, said to cause hypercalcaemia in normal adults, is officially 95 mg/day ie 4 000iu/d. But collective  reports  indicate that serum 25(OH)D concentrations need   to exceed 700 nmol/L ie 280 ng/ml chronically   before vitamin D3 toxicity becomes  evident ie from at least ~40 000iu D3 /day or perhaps a million iu monthly. .

update 30 June 2015: The Univ Toronto team  in the previous decade published more evidence of safety and benefit  of vit D3 up to 40 000iu a day 280 000iu/week; but   not 88 000iu/day: the warning is that calcium supplement should be avoided in such high vit D3 dosage. They were not yet advising supplement vit K2 and magnesium.                       Neurology . A phase I/II dose-escalation trial of vitamin D3 and calcium in multiple sclerosis.   Burton JM1, Kimball S, Vieth R   ea  St  Michael’s Hospital, Toronto, Canada.     Low vitamin D status has been associated with multiple sclerosis (MS) prevalence and risk; .  to assess the tolerability of highdose oral vitamin D prospectively, an open-label randomized prospective controlled 52-week trial matched patients with MS to treatment or control groups. Treatment patients received escalating vitamin D doses up to 40,000 IU/day (280 000iu/wk) over 28 weeks to raise serum 25-hydroxyvitamin D [25(OH)D] rapidly and assess tolerability, followed by 10,000 IU/day (12 weeks).. Calcium (1,200 mg/day) was given throughout the trial. Endpoints were mean change in  biochemical measures,  biomarkers, relapse events, and Expanded Disability Status Scale (EDSS) score.    RESULTS:   Forty-nine patients (25 treatment, 24 control) were enrolled [mean age 40.5 years, EDSS 1.34, and 25(OH)D 78 nmol/L]. All calcium-related measures within and between groups were normal. Despite a mean peak 25(OH)D of 413 nmol/L 164ng/ml, no significant adverse events occurred. Although there may have been confounding variables in clinical outcomes, treatment group patients appeared to have fewer relapse events and a persistent reduction in T-cell proliferation compared to controls.   Highdose vitamin D (approximately 10,000 IU/day) in multiple sclerosis is safe, with evidence of immunomodulatory effects.    This trial provides Class II evidence that highdose vitamin D use for 52 weeks in patients with multiple sclerosis does not significantly increase serum calcium levels when compared to patients not on highdose supplementation. The trial, however, lacked statistical precision. , providing only Class level IV evidence for these outcomes.

          Ann Clin Biochem. 2008;.   Self-prescribed highdose vitamin D3: effects on biochemical parameters in two men.     Kimball S1, Vieth R.   , University of Toronto, Toronto, Canada. ..  The lowest observed adverse effect level for vitamin D, said to cause hypercalcaemia in normal adults, is officially 95 microg/day 4000iu/d. Serum 25-hydroxyvitamin D (25[OH]D) concentrations associated with hypervitaminosis D remain undefined. Reported 25(OH)D concentrations resulting from prolonged excessive vitamin D3 intakes have exceeded 700 nmol/L 280ng/ml. We report self-prescribed high dose of vitamin D3 over 5-6 years by two men.               Subject 1 had been taking 100 microg/4000iu day for 3 years followed by 3 years of 200 microg/8000iu/day. Serum 25(OH)D concentrations averaged 130 nmol/L 52ng/ml while taking 100 microg/4000iu day of vitamin D3. While taking 200 microg/8000iu/day of vitamin D3, mean serum 25(OH)D concentrations were 260 nmol/L 102ng/ml with no hypercalcaemia or hypercalcuria over the 6 years of vitamin D3 intake.                                                  Subject 2 was a 39-year-old man diagnosed with multiple sclerosis.  his own dose-escalation schedule  increased from 200ugm 8000iu  to 2200 microg/ 88000iu/day over 4 years. The  evidence of a potential adverse effect was that urinary calcium:creatinine ratios showed an increasing trend, which preceded serum calcium concentrations above the reference range (2.2-2.6 mmol/L). His serum 25(OH)D concentration was 1126 nmol/L 450ng/ml  when total serum calcium reached 2.63 mmol/L. He stopped vitamin D3 supplementation at this point. Two months later, all biochemistry values were within reference ranges; serum 25(OH)D concentrations fell by about one-half, to 656 nmol/L 260ng/ml . These results help to clarify the human response to higher intakes of vitamin D3. Close monitoring of biochemical responses confirmed that an increase in urinary calcium:creatinine ratio precedes hypercalcaemia as serum 25(OH)D concentrations rise.

update 28 June : a landmark trial in Brazil 2 years ago finally shows what a really high dose of Vit D3 – 35000iu/d  can do safely over 6 months, a cumulative safe dose of 6million iu A pilot study assessing the effect of prolonged administration of high daily doses of vitamin D on the clinical course of vitiligo and psoriasis:  Dermatoendocrinol. 2013  Finamor,  Coimbra ea    University São Paulo, Brazil     Autoimmunity has been associated with vitamin D deficiency and resistance, and vitamin D metabolism gene polymorphisms   frequently described. May high dose vitamin D3  compensate for inherited resistance to its biological effects?.  To assess the efficacy and safety of prolonged high-dose vitamin D3 treatment of patients with psoriasis and vitiligo, 25 patients with psoriasis or  vitiligo received vitamin D3 35,000 IU once daily for six months ie >1million iu/mo,  >6 million iu over 6mo  in association with a low-calcium diet (avoiding dairy products and calcium-enriched foods like oat, rice or soya “milk”) and hydration (minimum 2.5 L daily). Psoriasis patients were scored according to “Psoriasis Area and Severity Index” (PASI) . All patients presented low vitamin D status (serum 25(OH)D3 ≤ 30 ng/mL) at baseline. After treatment 25(OH)D3 levels significantly increased (from~16 to ~120ng/mL)  ie increase of +- 100ng/ml by 35000iu dly – a flattened highdose response curve, only 10ng/ml rise per 3500iu/d;    and PTH levels significantly decreased (from ~57 to 27 pg/mL. PTH and 25(OH)D3 serum concentrations correlated inversely. The PASI score significantly improved in all nine patients with psoriasis. 14 of 16 patients with vitiligo had 25–75% repigmentation. Serum urea, creatinine and calcium (total and ionized) did not change and urinary calcium excretion increased within the normal range. High-dose vitamin D3 therapy may be effective and safe for vitiligo and psoriasis patients. WHAT WAS THEIR BMI? my 25OHvit D level runs at ~90ng/ml on ~9000iu vit D3 a day; and my  patient’s level runs at ~150ng/ml on ~15000iu/d… so perhaps the Brazilians with these skin disorders (unlike us) have  resistance genes that block higher levels of 25OHvit D. So without doing costly genotyping, we in practice need to check vit D level response early where very high dose is indicated in severe disease. .

Mediocre chronic dose vit D3 supp  eg 2000iu/d , 25OHvitD well > 30ng/ml-   is not enough– it needs high loading eg >400 000- 600 000iu  for acute illness, and good maintenance dose eg >5o 000- 75 000iu/wk  for blood level >60ng/ml, for chronic prevention, to maintain good vit D level and thus real protection:    BMJ Open Respir Res. 2015 Jun   Association between prehospital vitamin D status and incident acute respiratory failure in critically ill patients:  retrospective cohort study.  Thickett , Christopher ea:      Boston, Massachusetts , USA     Intensive care units of Boston teaching hospitals.  1985 critically ill adults admitted between 1998 and 2011    Exposure of interest was prehospital serum 25(OH)D categorised as ≤10 ng/mL, 11-19.9 ng/mL, 20-29.9 ng/mL and ≥30 ng/mL.  In the cohort, the mean age was 63 years,     25(OH)D was ≤10 ng/mL in 8% of patients, 11-19.9 ng/mL in 24%, 20-29.9 ng/mL in 24% and ≥30 ng/mL in 44% of patients. Eighteen per cent (n=351) were diagnosed with acute respiratory failure.  Prehospital 25(OH)D  30ng/ml  in our critically ill patient cohort.  

Thorax. 2015 Jun 10.Double-blind randomised controlled trial of vitamin D3 suppl for the prevention of acute respiratory infection ARI  in older adults and their carers (ViDiFlu).    Martineau , Griffiths ea.Univ London.  clinical trial of high-dose versus low-dose vitamin D3 supplementation for ARI prevention in residents of sheltered-accommodation housing schemes and their carers in London, UK.    137 individuals were allocated to the active intervention (vitamin D3 2.4 mg = 100 000iu once every 2months +10 μg =400iu daily for residents= 62 000iu/mo; carers 3 mg once every 2 months =60 000iu/mo);  and 103 participants to placebo once every 2 months +vitamin D3 10 μg daily = 12000iu/mo for residents, placebo once every 2 months for carers) for 1 year. RESULTS:Inadequate vitamin D status was common at baseline:  92% of 240  participants had serum 25(OH)D concentration < 30ng/ml. The active intervention did not influence time to first ARI (adjusted HR (aHR) 1.18, 95% CI 0.80 to 1.74, p=0.42). When URI and LRI were analysed separately, allocation to the active intervention was associated with 50% higher  risk of URI (aHR 1.48, 95% CI 1.02 to 2.16, p=0.039) and increased duration of URI symptoms (median 7.0 vs 5.0 days for active vs control, adjusted ratio of geometric means 1.34, 95% CI 1.09 to 1.65, p=0.005), but not with altered risk or duration of LRI.   CONCLUSIONS: Addition of intermittent bolus-dose vitamin D3 supplementation to a daily low-dose regimen to average  ~2000iu/d did not influence risk of ARI in older adults and their carers, but was associated with increased risk and duration of URI  over 400iu dly ie 12000iu spread over the month.

Thorax. 2015 May.   Double-blind randomised placebo-controlled trial of bolus-dose vitamin D3 supplementation in adults with asthma (ViDiAs).  Martineau ,Griffiths ea    London  University UK. Asthma exacerbations are commonly precipitated by viral upper respiratory infections (URIs). Vitamin D insufficiency associates with susceptibility to URI in patients with asthma.  randomised controlled trial of vitamin D3 supplementation for  prevention of asthma exacerbation and URI. 250 adults with asthma in London, UK were allocated to receive six 2-monthly oral doses of 120 000iu 3 mg vitamin D3 (n=125) or placebo (n=125) over 1 year.   206/250 participants (82%) were vitamin D insufficient at baseline. Vitamin D3 did not influence time to first severe exacerbation (adjusted HR 1.02, 95% CI 0.69 to 1.53, p=0.91) or first URI (adjusted HR 0.87, 95% CI 0.64 to 1.16, p=0.34). No clinically important effect of vitamin D3 was seen on any of the secondary outcomes listed above. The influence of vitamin D3 on coprimary outcomes was not modified by baseline vitamin D status or genotype. Bolus-dose vitamin D3 supplementation – 60 000iu/mo = average 2000iu/d – did not influence time to exacerbation or URI in a population of adults with asthma with a high prevalence of baseline vitamin D insufficiency.

update 27 June 2015  another review Safety of vitamin D3 in adults in multiple sclerosis  Kimball ,Vieth ea  2007 University  Toronto, Canada confirms that  up to at least 40 000iu daily for 28 weeks  is safe. Patients’ serum 25(OH)D concentrations reached twice the top of the physiologic range without eliciting hypercalcemia or hypercalciuria. The data provide objective evidence that vitamin D intake beyond the current upper limit is safe by a large margin.

      update  20 June 2015 : the  10th  HIGHDOSE VIT D STUDY  (100 000 to  600 000iu stat, or up to 55 000iu/day):       Quraishi,  Bhan ea 2009 Harvard Univ Boston: Effect of  Highdose VIT D Supplement on Vitamin D Status and Cathelicidin Levels in Sepsis: Crit Care Med. 2015 Jun 17: RCT  to compare changes in vitamin D status and cathelicidin (LL-37) levels in 30  adult ICU patients given  Placebo (n = 10) vs 200,000 IU cholecalciferol (n = 10) vs 400,000 IU cholecalciferol (n = 10), within 24 hours of new-onset severe sepsis or septic shock in a single Boston, MA teaching hospital.  Blood samples  at baseline (day 1) and on days 3, 5, and 7. At baseline, median (interquartile range) plasma 25-OHvitD  was 17 ng/ml,  peaked by day 5 in  intervention groups.  On day 5, median change in biomarkers for placebo, 200,000 IU vit D3 cholecalciferol , and 400,000 IU vit  D3 groups, respectively, were as follows: 1) total 25OHvitD, 3% (-3% to 8%), 49% (30-82%), and 69% (55-106%) (p < 0.001); 2) bioavailable 25OHvitD, 4% (-8% to 7%), 45% (40-70%), and 96% (58-136%) (p < 0.01); and 3) LL-37 : -17% (-9% to -23%), 4% (-10% to 14%), and 30% (23-48%) (p = 0.04). Change in high-sensitivity CRP levels did not differ between groups. A positive correlation was observed between bioavailable 25OHvit D and LL-37 (Spearman ρ = 0.44; p = 0.03) but not for total 25OHvitD and LL-37. CONCLUSIONS:High-dose vitD3 supplement rapidly and safely improves total  and bioavailable 25OHvitD  levels in patients with severe sepsis or septic shock. Changes in bioavailable 25OHvitD are associated with concomitant increases in circulating LL-37 levels.

Clin Nutr. 2015 Apr 14.    Increases in pre-hospitalization serum 25(OH)D concentrations are associated with improved 30-day mortality after hospital admission: A cohort study in Boston, Mass.. Amrein , Christopher ea   in two Boston univ. hospitals .Pre-hospital vitamin D status may be a modifiable risk factor for all-cause mortality among hospitalized patients.  4344 adults hospitalized between 1993 and 2011..  INTERVENTION(S):  None.  The main outcome was 30-day all-cause mortality.  In an adjusted logistic regression model, absolute changes of ≥10 ng/mL in patients with initial 25(OH)D  < 20 ng/mL (n = 1944) decreased the odds of 30-day all-cause mortality by 48% (adjusted OR 0.52, P = 0.026).  A causal relation may not be inferred from this observational study.
      Conversely, another new study this month confirms the hazard of gross overdose of anything:   Kaur, Mithal ea .India Vitamin D toxicity resulting from overzealous correction of vitamin D deficiency  Clin Endocrinol (Oxf). 2015 Jun “Vitamin D toxicity, wrongly  considered rare, can be life-threatening,  with substantial morbidity, if not identified promptly. In 16 patients with vitamin D toxicity seen between January 2011 and January 2013  Clinical manifestations included nausea, vomiting, altered sensorium, constipation, pancreatitis, acute kidney injury and weight loss. Median (range) age was 64.5 (42-86) years. Median  serum 25(OH)D level  371 (175-1161) ng/ml, serum total serum calcium level  13.0 (11.1-15.7) mg/dl . Irrational Overdose of vitamin D caused by prescription of mega doses of vitamin D was the cause of vitamin D toxicity in all cases. Median (range) cumulative vitamin D dose was 3,600,000 (2,220,000-6,360,000)”– but the abstract doesnt mention the timespan . Generally, after loading dose for urgent risk,  maintenance dose  need  not exceed about 80 iu/kg/d eg 7000iu/day ie ~50 000iu/wk or 2500 000 iu/yr, ideally with ideally occasional blood vit D, calcium & creatinine tests. .

           UPDATE FOR KIDS: Pediatr Rheumatol Online J. 2015 May .  Vitamin D-update for the pediatric rheumatologists.    Vojinovic J1, Cimaz R2. University of Nis, Serbia.   ” So in accordance with new vitamin D recommendations, we recommend that a child with rheumatic disease, especially if treated with steroids, needs at least 2-3 time higher doses of vitamin D than the dose recommended for age (approximately 2000 UI/day). Vitamin D supplementation has become an appealing and important adjunct treatment option in PRD

      17 June update : Proc Natl Acad Sci U S A. 2015 Jun 15. pii: 201500909.           High-dose vitamin D3 reduces deficiency caused by low UVB exposure and limits HIV-1 replication in urban Southern Africans.  .Cape Town, South Africa, has a seasonal pattern of UVB radiation and a predominantly dark-skinned urban population who suffer high HIV-1 prevalence. This coexistent environmental and phenotypic scenario puts residents at risk for vitamin D deficiency, which may potentiate HIV-1 disease progression. Coussens ,  Jablonski   ea  from Univ. Cape Town & Stellenbosch conducted a longitudinal study in two  Cape Town ethnically distinct groups of healthy young adults, supplemented with 50 000iu weekly  vitamin D3  for 6 weeks  in winter, to determine whether vitamin D status modifies the response to HIV-1 infection and to identify the major determinants of vitamin D status (UVB exposure, diet, pigmentation, and genetics). Vitamin D deficiency was observed in the majority of subjects in winter and in a proportion of individuals in summer, was highly correlated with UVB exposure, and was associated with greater HIV-1 replication in peripheral blood cells. High-dosage oral vitamin D3 supplementation attenuated HIV-1 replication, increased circulating leukocytes, and reversed winter-associated anemia. Vitamin D3 therefore presents as a low-cost supplementation to improve HIV-associated immunity.
    16 June 2015  REVIEW: ADULTS: WHAT VIT D DOSE IS ENOUGH? Because of our increasingly government-encouraged soporific  TV lifestyle and western processed- food-factory low-fat high-carbs HCLF diet, vitamin D has turned out to be as important as >vitamin C as the seriously deficient primary major nutrients in far higher than scurvy/rickets prevention doses.
Just as we ‘only’ need vitamin C 10mg/d to prevent scurvy, the historical DAILY recommended allowance RDA dose of vitamin D for rickets is ‘only’ ~10mcg 400iu/d.
But current expert opinions advocate  effective multisystem chronic prevention against infections, cancer, neurological, cardiovascular and bone disease in adults  vit C between 1gm  and 30gm/day; and

       vit D between 100mcg 4000iu and 250mcg 10 000iu/d (ie 80-100iu/kg/d); or about 25000 to 70 000iu/week or equivalent spacing;
to a blood 25hydroxyvit D 25OHvitD level of ~60 (40 to 80ng)/ml for global prevention; but around ~100ng/ml depending on severity of illness being targeted.

     DONT REJECT A SUPPLEMENT AS OF NO VALUE JUST BECAUSE IT TESTED INEFFECTIVE  IN  LOW DOSE:   eg Martineau , Griffiths ea.Univ London Thorax. 2015 Jun   Double-blind randomised controlled trial of vitamin D3 supplementation for the prevention of acute respiratory infection in older adults and their carers (ViDiFlu). CONCLUSION: Addition of intermittent bolus-dose vitamin D3 supplementation to a daily low-dose regimen did not influence risk of ARI in older adults and their carers, but was associated with increased risk and duration of URI.   BUT like so many trials,this trial in  240 London Seniors and carers is not about high dose, but mediocre dose, in small numbers: it  confirms that 100 000iu vit D3 every 2 mo ie average ~extra  1666iu/d is no better protection than just 400iu dly ie 12000iu spread over the month.

Since like all steroids the many vitamin Ds are vitamin C-cholesterol-derived oils stored and carried in fat, the fatter the patient the higher the maintenance dose vit D3 (eg 100 iu/kg/d) to maintain a good steady optimal bloodlevel.                                Fortunately, unlike the other essential physiological human anabolic steroids (eg androgens, progesterone and estrogens that are poorly absorbed , and trans-hepatically dangerous if swallowed), vitamin D3 is well absorbed either by mouth, by injection; or transdermally / intranasally; and apparently not degraded to risky byproducts in the liver as are the “sex” steroids. .

And of course for best absorption, fat-soluble essentials like vits A, D, E , K; CoQ10 & alphalipoic acid ALA are best eaten with fat not carbs eg veggies, cereals or on empty.
To minimize risk of stones and vascular calcification from imbalance, it is important to take vit D3 with                                                                                      *liberal water, magnesia and vitamin K2; perhaps                                                 *~30gms fresh marine oil /wk eg a tsp of cod liver oil 3 x a week; and                       * a few tsp/d of virgin coconut oil (and for cooking/frying in);
*at least half of daily non-protein energy as FATS- animal, dairy and avocado &
*while minimizing moderate omega6 as nuts and raw olive/ oil; and avoiding/minimizing diabesogenic insulin-resistance-causing refined carbs, and synthetic junk fats like margarine, and other seed oils- eg sunflower and canola – certainly not for frying.

A new university study from Ireland ( Endocr Connect. 2015 June. McKenna ea) confirms that average vitamin D levels there are still well below sufficiency let alone good levels, although it finds Rising trend in vitamin D status from 1993 to 2013: “The Institute of Medicine 2011 Dietary Report specified higher Vitamin D intakes for all age groups compared to 1997, but also cautioned against spurious claims about epidemic vitamin D deficiency and against advocates of higher intake requirements. 40 years have seen marked improvement in vitamin D status, but we are concerned about hypervitaminosis D. Time series sequence chart demonstrated a steady upward trend with seasonality. The average 25OHD increased by ~50% from ~15ng/ml in 1993 to ~23ng/ml in 2013. CONCLUSIONS: Vitamin D status improved over the past 40 years, but there is a dual problem:                             *groups at-risk of vitamin D deficiency, who need public health preventative measures; and                                                                                                     *random members of the public  taking unnecessarily high vitamin D intakes for unsubstantiated claims. “

       Last year Autier, Mullie ea from Lyon France and Bolland, Reid ea from Auckland NZ published major reviews concluding that “In elderly people, restoration of vitamin D deficits due to ageing and lifestyle changes induced by ill health could explain why low-dose supplementation leads to slight gains in survival.  And “vitamin D supplementation with or without calcium does not reduce skeletal or non-skeletal outcomes in unselected community-dwelling individuals by more than 15%. Future trials with similar designs are unlikely to alter these conclusions
But Gillie from Health Research Forum, London 2014 in Controlled trials of vitamin D, causality and type 2 statistical error  rebuts Autier ea, Bolland ea:    “In Lancet Diabetes Endocrinol, Autier, Mullie ea. (2013) , and Bolland, Reid ea. (2014) , concluded that low levels of vitamin D are not a cause but a consequence of ill health brought about by reduced exposure to the sun, an association known as ‘reverse causality’ Denial of the possible benefits of vitamin D, as suggested by insistent interpretation of studies with reverse causation, may lead to serious harms, some of which are listed.” So Gillie affirms the focus of this June 2015 review on vigorous dose vit D without chronic toxic overdose, that Autier ea and Bolland ea overlook, that their conclusions were based on lowdose vitamin D, not vigorous dose eg loading dose 600 000iu  monthly with or without ~50 000iu weekly that has been increasingly validated.

         COMBINED BALANCE ALWAYS BEST:
While  human sex hormones in good youthful balance are all essential physiological anabolic ie growth-promoting steroids, Atif ea at Emory University, Atlanta, 2009  and 2015   showed that in rats, Vitamin D with progesterone P4 supplement affords significantly better brain protection against excitotoxicity in cultured cortical neurons  and in traumatic brain injury in vivo than progesterone or vit D alone. In their 2009 braincell culture experiment, the optimal ratio of the hormones given was Prog:Vit D 1000:1 (Prog 20 umol/L: vitD 20nmol/L); whereas in their 2015 in life study the ratio was 8000:1– the rats were injected intraperitoneally  Prog 16mg/kg and VitD 1ug  one and 6 hours after the brain injury, and at 24 hours after brain injury they were killed and the brain damage compared. The optimal ratio, balance of the two steroid  hormones  for rat brain protection (1000:1 in a bench cellculture  and 8000:1 in an acute living rat model) is noteworthy for human dosing although the absolute doses cannot be extrapolated to living humans.   In humans this review below shows that the optimal acute dosing thus far reported seems to be  about 1000mg progesterone injection ie ~13mg/kg (some disputed trial evidence for protecting human brain injury after 50 years of research), and vit D for acute global protection about  600 000iu = 10 000iu/kg= 250 ug /kg ie P:vitD ratio about 50:1.

But vit D3, & androgens, and progesterone (eg Roeder 1986 & Starkov 1997), are the classic muscle-bone anabolic (ie growth- protein-water-salt-retaining) steroids. So we should always combine them in appropriate dose if needed for men, and even women. Estrogen is essential for reproduction, bone strength and femininity, but is muscle-anabolic only for the female reproductive tract; and for fat and glandular tissue ie breasts: estrogenic  dominance doubles cancer; adiposity;  sarcopenia;  and urinary incontinence ie weakens the pelvic floor; so should never be given unopposed by progesterone/androgen and vigorous vit D3 .

          ACUTE LOADING DOSE OF VIT D?: Like antibiotics, for acute (antimicrobial or ICU metabolic eg vascular, brain, cancer ) disease, adult vitamin D3 LOADING dose 540 000 to 600 000iu monthly – but not much lower loading dosing – has been recommended and proven major benefit, eg

1. New Zealand 2009 Osteoporos Int. ;20:1407-15.. Bacon ea :              High-dose 500 000iu oral vitamin D3 supplementation in the elderly were concerned that: vitamin D doses are frequently inadequate; compliance with daily medication is likely to be suboptimal; large loading doses of vitamin D(3) rapidly and safely normalize 25OHD levels; and monthly dosing is similarly effective only after 3-5 months. With baseline 25OHD > 20ng/ml, vitamin D supplement does not reduce parathyroid hormone PTH levels. This randomized double-blind trial RCT compares “high-dose” vitamin D3 regimens and estimates optimal 25OHD levels, from changes in PTH & procollagen type I propeptide (P1NP) in relation to baseline vit D . Sixtythree elderly participants were randomized to three regimens of vitamin D supplementation: a 500,000-IU loading dose; the loading dose plus 50,000 IU/month; or 50,000 IU/month. the Loading and Loading + Monthly groups showed increases in 25OHD of 23+/- 11ng/ml from baseline to 1 month. Thereafter, levels gradually declined to plateaus of 27 +/- 2 ng/mlL and 36 +/- 2 nmol/l, respectively. In the Monthly group, 25OHD reached a plateau of ~32 +/- 8 ng/dl at 3-5 months. There were no changes in serum calcium concentrations. PTH and P1NP were only suppressed by vitamin D treatment in those with low baseline 25OHD level.. CONCLUSIONS: Large loading doses of vitamin D(3) rapidly and safely normalize 25OHD levels in the frail elderly. Monthly dosing is similarly effective and safe, but takes 3-5 months for plateau 25OHD levels to be reached.

2, Pakistan 2013 Salahuddin N ea:  600 000IU Vitamin D monthly for 2 doses improves clinical recovery from tuberculosis. 259 patients with pulmonary TB were randomized to receive either 600,000 IU of Intramuscular vitamin D3 ie ~20 000iu/day, or placebo for 2 doses. After just 12 weeks, the vitamin D supplemented arm demonstrated significantly greater ~40% improvement: mean weight gain (kg)+3.75, (3.16-4.34) versus+2.61 (95% CI 1.99-3.23) p 0.009 and lesser residual disease by chest radiograph; number of zones involved 1.35 v/s 1.82 p 0.004 (95% CI 0.15, 0.79) and 50% or greater reduction in cavity size 106 (89.8%) v/s 111 (94.8%), p 0.035.

3. Austria 2014  Amrein ea, 540 000iu loading dose in 475 ICU pts significantly reduced morbidity and mortality by 40% in 492 vit D deficient pts,  ie is anabolic ie reverses muscle wasting – sarcopenia. as also found by Aganostis 2015 metanalysis

4. Canada/USA universities 2014 Ekwaru, Holick ea: “in a survey, 17,614 Healthy volunteers reported vitamin D supplement ranging from     0 to    55000iu/day= ~1.65million iu/mo; and had serum 25(OH)D levels ranging from 4 to 160ng/ml. The dose response relationship between vitamin D supplementation and serum 25(OH)D followed an exponential curve. On average, serum 25(OH)D increased by 5ng/ml per 1,000 IU in the supplementation interval of 0 to 1,000 IU /day; and by 92% less eg 0.4ng/ml per 1,000 IU in the supplementation interval of 15,000 to 20,000 IU per day. BMI, relative to absolute body weight, was found to be the better determinant of 25(OH)D. Relative to normal weight subjects, obese and overweight participants had serum 25(OH)D that were on average 8 and 3 ng/ml lower, respectively (P<0.001). We observed no increase in the risk for hypercalcemia with increasing vitamin D supplement.”

5. Pakistan 2015 April 22nd Endocrine Society seminar RCT : Vit D3 up to 600 000iu loading dose : Prof Muhammad Masood, Consultant Endocrinologist of Aga Khan University : “ How Much Vitamin D We Need?” vit D deficiency VDD has resurfaced as significant health problem in recent years. In Pakistan region, VDD is very prevalent despite adequate sunshine throughout the year. A huge number of studies associate Vitamin D deficiency with almost any disease. Recently, concerns about the safe upper level of vitamin D have been raised and a reverse J or U shaped relation has been described with 25-OHD level and mortality. Increasing number of patients are being reported with vitamin D toxicity because of excessive intake of vitamin D resulting from misinterpretation of prescription, manufacturing errors, inappropriate prescription of excessive vitamin D doses for vague musculoskeletal complaints without monitoring 25-OHD concentrations. A study conducted at our center revealed important implications, first a dose of VD3 ranging from 200,000-600,000 IU given orally or IM will correct the deficiency in more than 70% of individual at 2 months. A dose of vitamin D 600,000 IU given IM will correct the deficiency in more than 90% of individuals and maintained levels > 20ng/ml in 84% of individuals at 6 months. Multiple mega doses may pose the risk of toxicity.”
6 Belgium 2014.:Vitamin D status after a 100 000iu highdose cholecalciferol in healthy and burn subjects. Rousseau ea Burns patients are at risk of vitamin D (VDD) deficiency and may benefit from its pleiotropic effects in acute phase. Two groups received an oral dose of 100,000IU VD3 RESULTS:A total of 49 subjects were included: 29 in GHealth and 20 in GBurns. At D0, prevalence of VDD was higher in GB: 25OH-D was 21.5 (10.1-46.3) ng/ml in GH vs 11 (1.8-31.4) ng/ml in GB. DBP and ALB were lower in GB. At D7 In GB, changes in 25OH-D extended from -36.7% to 333.3% with a median increase of 33.1%. This study highlighted the differences in VD status and in response to a high dose VD3 in burn patients when compared to healthy patients. 25OH-D measurement needs cautious interpretation, should not prevent burn patients to receive VD supplements during acute care. Higher doses than general should probably be considered

7 Canada 2015 Jan; up to 300 000iu vit D3 loading: McNally Univ Ontario ea Rapid normalization of vitamin D levels: a meta-analysis.. systematic review of pediatric clinical trials of high-dose vitamin D with 25[OH]D.., selected 88 Uncontrolled and controlled trials reporting 25(OH)D levels after high-dose (≥1000 IU) calciferol. Two of 6 studies that administered daily doses approximating the Institute of Medicine’s Tolerable Upper Intake Level (1000-4000 IU) to vitamin D-deficient populations achieved group 25(OH)D levels >30ng/dl within 1 month. Nine of 10 studies evaluating loading therapy (>50 000 IU) achieved group 25(OH)D levels >30ng/dlL. Adverse event analysis identified increased hypercalcemia risk with doses >400 000 IU, but no increased hypercalcemia or hypercalciuria with loading doses 300 000 IU. . CONCLUSIONS: Rapid normalization of vitamin D levels is best achieved by using loading therapy that considers disease status, baseline 25(OH)D, and age (or weight). Loading doses >300 000 IU should be avoided until trials are conducted to better evaluate risk and benefit.
Australia: some Australians are fearful in claimed cautious ignorance: Sanders ea University of Melbourne 2013 ask Is high dose vitamin D harmful? With potential to minimize risk of many chronic diseases, and apparent biochemical safety of ingesting doses of oral vitamin D several-fold higher than current recommended intakes, recent research has focused on supplementing intermittent, high-dose vitamin D. However, two recent randomized controlled trials (RCTs) both using annual high-dose vitamin D reported an increase, rather than a decrease, in the primary outcome of fractures.” So annual megadose doesnt help in prevention?.
but they are planning bold highdose trial:                                                                                    8. BMC Cancer. 2014 Saw ea Melanoma Institute, SydneyAdjuvant therapy with 500,000 IU high dose vitamin D following primary treatment of melanoma; Patients with primary cutaneous melanomas that are ulcerated and >2 mm in thickness, or nodal micrometastases, have few options for adjuvant treatment. Recent studies suggest a role for vitamin D to delay and improve overall prognosis. This pilot placebo-controlled randomised phase II trial will assess feasibility, safety and toxicity of an oral loading dose of Vitamin D (500,000 IU) followed by an oral dose of 50,000 IU of Vitamin D monthly for 2 years in patients treated by wide excision…”

        9 INDIAN PEDIATR 2014 :   300,000 IU or 600,000 IU RCT. Mittal ea Delhi. 76 children (median age 12 mo) with rickets. Oral vitamin D3 as 300,000 IU (Group 1; n=38) or 600,000 IU (Group 2; n=38) in a single day. 25(OH)D levels increased from baseline to 12 weeks after therapy :[Group 1: 7.58 to 16.06 (12.71– 20.29) ng/mL, P<0.001]; Group 2: 6.57 (4.66–9.25) to 17.60 . ie 25(OH)D levels were deficient (

But while all the data above are too heterogenous to do a metaanalysis, we now know as well as the South Africans, Pakistanis, Indians, Americans, Canadians, ANZIOs and Austrians do from this literature analysis and collective experience that a level of 25OHvit D of 20 or 40ng/ml is not adequate protection; conversely a bloodlevel of ~>200ng/ml has to be exceeded long term to incur risk. And a loading adult dose orally in adults of at least 600 000iu vit D3 – more likely >1 million iu- (that’s 6gm of 100cwt vit D concentrate powder, costing perhaps $0.25 in South Africa) taken with fat -may be needed to achieve safe high enough bloodlevel to have acute protective effect- and the vit D bloodlevel will drop below vigorous levels within weeks without maintenance doses, as the Austrian study used after their loading dose 540 000iu..

so even 50 000iu every week – my standard chronic illness adult maintenance dose that I take- is ineffective initially for acute protection in eg TB adults (Daley ea India 2015) or ICU . It seems such adults (pneumonia, TB, acute AIDS, ICU) need ? 600 000iu (or ? a ~ million iu orally) to start, then eg 100 000iu/wk till better, then drop to maintenance. .

            VIT D & INFANTILE BRONCHIOLITIS
Infantile bronchiolitis is a severe and common occurrence and killer under a year of age in South Africa as in the northern hemisphere; especially in tiny premmies; in the majority due to RSV respiratory syncytial virus rather than coronavirus, ‘flu etc; with no conventional therapy except support- leaving the doctor actively doing nothing except comfort, while the nurse nurses…
BUT eight papers since 2011 on Bronchiolitis strongly support vit D: that vitamin D deficiency/ polymorphism plays a major role from pregnancy on:
Three studies from 2011-2014 show that such bronchiolitis infants have low vitamin D or vitamin D polymorphisms that make them vulnerable; Two studies in 2014, from Harvard (Randolph ea ) and Ottawa (McNally ea) Universities in RSV bronchiolitis infants show vit D-binding haplotype, or Vitamin D receptor (VDR) polymorphisms;      And a 2011 study from Belderbos ea Utrech Univ Netherlands 2011 that Cord blood vitamin D deficiency is associated with respiratory syncytial virus bronchiolitis- Neonates born with 25-OHD concentrations <20ng/ml had a sixfold (95% confidence interval: 1.6-24.9; P = .01) increased risk of RSV LRTI in the first year of life compared with those with 25-OHD concentrations ≥ 30ng/dl. These studies thus point to brisk vitamin D supplement as likely major benefit against both RSV and subsequent asthma./COPD.

and Five recent team reviews 2011 to 2014 of RSV bronchiolitis from Italy—Baraldi ea ;   Canada- Poon ea ; Ireland – Clancy ea; and USA: Herzog ea-Cornell Univ NY, and Massachusetts-Maxwell ea – thus encourage the use of vigorous vitamin D and A and omega3 supplements in pregnancy or infancy to prevent  our  high RSA risk of bronchiolitis and future asthma/COPD.  eg
Curr Drug Targets. 2011.Herzog ea Cornell Univ. Immunologic impact of nutrient depletion in chronic obstructive pulmonary disease. Maternal smoking may diminish interferon response secondary to micronutrient deficiency, particularly of Vits A & D, and support persistence of RSV into adult life , Muscle wasting and cachexia systemic features of COPD. Nutritional depletion is related to poor survival and is a rational target for therapeutic intervention also in advanced and critically ill patients. Preliminary studies and suggest that supplementation with omega-3 and Vitamin A, Vitamin D3, and zinc may have beneficial effects in COPD.

now    2015  Salimi ea in Iran show in  Association between vitamin D receptor polymorphisms and haplotypes with pulmonary tuberculosis  in  Biomed Rep.   “The vitamin D receptor (VDR) is an important factor in activating immune response in different infectious diseases. Case control study on 120 PTB patients and 131 healthy controls with  Genetic analysis  by polymerase chain reaction.. The VDR Fok1 Ff genotype was associated with TB and the risk of PTB was two times higher in individuals with the Ff genotype. A higher frequency of f allele was observed in PTB patients and therefore, the f allele may be a risk factor for PTB susceptibility. In addition, haplotype analysis showed that the f-T-B and f-t-b haplotypes (Fok1, Taq1 and Bsm1) may have the potential to increase PTB susceptibility. In conclusion, the Ff genotype and f allele of the VDR Fok1 polymorphism were associated with PTB susceptibility. In addition, the f-T-B and f-t-b haplotypes may be the susceptible haplotypes for PTB.”

     THE RSA HOLOCAUST ESPECIALLY FOR WOMEN AND KIDS:  This new cumulative data above  is crucial given that while men fight ruthlessly for power, sex, money- even wars- the high birthrate in poor malnourished teenage girls in RSA, (especially with prevalent violence, alcohol, smoking and other drug abuses, AIDS and pulmonary and abdominal/ meningeal TB), who are thus ill-equipped both to breastfeed and parent with the myriad burdens of illiteracy and joblessness poverty, single parenting, starvation, male violence, refugee squatter survival, and then having to take ARVs, antiTB drugs or at least INH, cotrimoxazole and frequent other antimicrobials.

It is controversial, but Marks DF1.Br J Health Psychol. 2007 Department of Psychology, City University, UK argues that Literacy not intelligence moderates the relationships between economic development, income inequality and health: ” Kanazawa (2006) presented data allegedly supporting a racist version of evolutionary psychology that claims that the populations of wealthier and more egalitarian societies live longer and stay healthier, not because they are wealthier and more egalitarian, but because they are more intelligent. The objectives of this study are: (i) to determine the relationship between IQ and literacy in Kanazawa’s sample of countries and (ii) to reanalyse Kanazawa’s dataset using measures of literacy in lieu of national IQ test scores. RESULTS:National literacy scores across the countries in the sample are highly skewed. In spite of this, the literacy measures are highly correlated with alleged differences in national IQ (r = .83-.86). The measure of literacy together with economic development (GDPpc) and income inequality (Gini coefficient) control at least 59-64% of the variance in national life expectancy at birth.CONCLUSIONS:There is no scientific justification for believing that alleged intelligence differences play any role in explaining international differences in health status. Measures of alleged national IQ scores are highly confounded with differences in literacy. Literacy is a key factor in the health of any community and policies designed to enhance the literacy of a population are expected to lead to significant improvements in health status.
For these intellectually challenged illiterate women from remote rural villages  – many of whom cannot even write their initials let alone a signature, or understand English or Afrikaans-   anything but their tribal dialect-  pregnancy and AIDS/TB are the only relative escape from starvation and manual ie servile labour- which marginally paid drudgery is disappearing with the government-caused collapsed SA economy, power supply and industry. But the disability grant of ~R1500 ($125pm ie <$1/work hour) ) pm, and child welfare grant of perhaps R300 ($25)pm, is a drop in their ocean of despair. And given the mushrooming STD rates and costs thereof from male recklessness , from worsening corrupt central-government- led illiteracy and effective mass unemployment – state HIV-TB clinics and hospitals seldom have a little B6 or C to give these women, let alone regular supplies of ARVs or essential healing nutritionals eg vits A, Bco, minerals D, iodine, zinc, and biologicals eg  cod liver oil etc.

In the private sector, medical aid schemes also dont pay for supplements, only synthetic designer drugs that ignore underlying causal immunodeficiencies – since Only Disease Pays.
OVERDOSE? Between the two topic headings Hypervitaminosis D and Vitamin D toxicity, there are already 1798 refs on Pubmed alone. Hypervitaminosis D  428 reports on Pubmed since the first, from Harris & Moore, The Nutrition Lab, Cambridge 1929; Hypervitaminosis and vitamin balance: ..        and there are 1436 entries under Vitamin D toxicity since the first Vitamin D Toxicity by Leake 1936 at  UCLA .
ADULTS: But experts and numerous overdose reports ( only a few of which are noted below) reveal the truth,  that at least oral DAILY, well over 50 000iu to 1 MILLION iu/d of vitamin D for months, LONGTERM to up to 100 000IU/D for months to 365 million iu over 10 years has to be taken to cause illness ie symptomatic hypercalcemia .
Conversely, Chakraborty ea at Roy Research Center, Kolkata, India, report (Lab Med. 2015) A nontoxic case of vitamin d toxicity, a woman who developed very high serum Vitamin D levels (746 ng/mL, RI: 20 to 50) as a result of medication error. In spite of such high serum concentrations the patient was without any clinical symptoms and had normal serum calcium. The evidence base regarding the safety profile of Vitamin D supplementation in humans has been build through case reports, not dose titration RCTs to astronomical levels- which would be unethical.

So while routine maintenance dose eg 600 000iu/month, or 4000- to 10 000iu/d, or 100 000iu/wk in adults has never been reported to cause overdose toxicity,
on vigorous chronic vitamin D3 (not calcium or D2) dosing for disease, obviously ideally baseline (or at least after say 2-3 months of trial of conservative vitamin D replacement) calcium, vitamin D and kidney function levels should be measured since very rarely, unexpected silent hypercalcemia may already be present. .
But numerous reports eg from Netherlands 2014 show that a single overdose of even 2million iu vit D (=~100 000iu/d over 30days given the T 1/2 of vit D of 2 wks to 2 months), while kicking the bloodlevel up a few hundred ng/ml, does no harm even in two Dutch nonagenarians.

Relative hypovitaminosis D (bloodlevel below 30ng/ml) is prevalent locally and internationally in an indoor-working sunburn-fearing over-dressed city population not taking supplements more than the usual 400iu vit D in a daily multivite – especially in alcoholics, and the undernourished poor, and those following the government -recommended disease- promoting diabesogenic high- carbs low- fat diet marketed by commercial interests and bad science the past 50 years..

Already in 1999 Vieth at Univ Toronto wrote in Am J Clin Nutr. “Vitamin D supplementation, 25-OH vit D concentrations, and safety. . for adults, the 5-microg (200 IU) vitamin D RDA may prevent osteomalacia in the absence of sunlight, but more is needed to help prevent osteoporosis and secondary hyperparathyroidism, and prevention of some cancers, osteoarthritis progression, multiple sclerosis, and hypertension. Total-body sun exposure easily provides the equivalent of 250 microg (10000 IU) vitamin D/d, suggesting that this is a physiologic limit. The assembled data from many vitamin D supp. studies reveal a curve for vitamin D dose versus serum 25(OH)D response that is surprisingly flat up to 250 mcg (10000 IU) vitamin D/d. To ensure that serum 25(OH)D concentrations exceed 40ng/ml, a total vitamin D supply of >100 microg (4000 IU)/d is required. Except with conditions causing hypersensitivity, there is no evidence of adverse effects with serum 25(OH)D concentrations <55ng/ml, which require a total vitamin D supply of 250 microg (10 000 IU)/d to attain. Published cases of vitamin D toxicity with hypercalcemia, for which the 25(OH)D concentration and vitamin D dose are known, all involve intake of >/= 1000 mcg (40 000 IU)/d. Because vitamin D is potentially toxic, intake of >1000 IU/d has been avoided – even though the weight of evidence shows that the currently accepted, no observed adverse effect limit of 2000 Iu)/d is too low by at least 5-fold ie >10 000iu/d long term.”
O/Dose INFANTS: to avoid vitamin D poisoning and permanent damage to infants, of course dose needs to be scaled down accordingly on the 100iu/kg/d basis; but infants have a much bigger body surface area and thus meds requirement & tolerance. Human breast milk vit D is usually inadequate especially for swaddled darker-skinned babies and mothers; so conventionally at least 1000iu/d supplement vit D is for babies up to 6 months, 2500iu/d above 1year, and 4000iu/d from 9 years; or a pro rata loading dose, is advised eg Canada http://www.cps.ca/documents/position/vitamin-d and USA Heaney ea http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. Conversely, serum 25(OH)D concentration consistently >200 ng/mL is considered to be potentially toxic [5].” Without a fingerprick vit D and calcium assay (lab cost here is ~R300 ie $25), monitoring here is tedious and costly…
ALLERGY TO VITAMIN D3? That vigorous vitamin D3 replacement can improve immunodeficiency and even relieve dermatitis is common cause.
But since Vit D’s discovery in 1914 (USA McCollum and Davis) and soon commercial production and marketing the past 90 years, not a single documented verified ALLERGY case (not overdose) can be found on Pubmed or Google?.Such true allergy cannot be anything but very very rare, since with vit D3, like all other bioidentical human hormones, and vitamins, allergy (unlike overdose) is almost inconceivable- although receptor loss or blockade may create resistance to eg thyroid, testosterone, vit D etc. . Allergy could conceivably occur to some carrier/ additive to the vitamin D3- but not even in the lungs from inhalation of old high-vit D oil droplets in fish factory workers
VitaminDwiki puts it in perspective. Designer ie prescription synthetic meds, and common foods, and tap water, are more likely to cause problem.

None of the 14 refs on Pubmed reports allergy to vitamin D. Google merely notes some anecdotes from users.

The last and urgent word today  -on medical and parental responsibilities- is by Wolfgang Högler ,Birmingham Children’s Hospital, UK ,Clin.Endoc. 2015: Complications of vitamin D deficiency from the foetus to the infant: One cause, one prevention, but who’s responsibility? The supplier of bone Calcium and phosphorus is the hormone calcitriol, which originates from vitamin D, itself made by sunshine in human skin. Requirement for bone minerals is highest during phases of rapid growth, and no one grows faster than the foetus and the infant, making them particularly vulnerable. Deprivation of calcium, whether through low calcium intake or low vitamin D, leads to serious health consequences throughout life, such as hypocalcaemic seizures, dilated cardiomyopathy, skeletal myopathy, congenital and infantile rickets, and osteomalacia.                                                                                                                    These 5 conditions are often summarised as ‘symptomatic vitamin D deficiency’, are fully reversible but also fully preventable. However, the increasing prevalence of rickets and osteomalacia, and the deaths from hypocalcaemic cardiomyopathy, demand action from global health care providers. Clarification of medical and parental responsibilities is a prerequisite to deliver successful prevention programmes.     The foetus and infant have the human right to be protected against harm, and vitamin D supplementation has the same public health priority as vaccinations.

And Dr John Cannell of The Vitamin D Council comments today : Dr. Hogler does not discuss the growing evidence that maternal and infantile vitamin D deficiencies may lead to neurodevelopmental disorders such as autism. I have always thought that the only way obstetricians and pediatricians will prescribe adequate doses of vitamin D is if they are charged for malpractice from failing to identify and treat vitamin D deficiency. If it is established that vitamin D deficiency causes autism, the malpractice attorneys will swarm like sharks to blood. Given increasing evident harms from numerous vaccinations, and often lack of real longterm supporting evidence of good eg the (swine and seasonal) flu and cervix HPV vaccines, we must consider vitamin D supplementation as far more proven benefit and safety than intensive multiple vaccinations.
-And on sepsis and brain salvage:  Dr Cannell promotes   –  vitamin D is a viable treatment for sepsis?, the landmark work of Drs William Grant and Ray Matthews.

The evidence is strong that vigorous natural supplements (vits, minerals, human hormones and some natural biological like marine oil and chondroglucosamine) are priorities especially in both acute emergencies, chronic diseases and prevention, from conception at all ages, over vaccinations and antibiotics and all synthetic designer drugs. .

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REFS:
BMC Cancer. 2014 ;14:780 Adjuvant therapy with high dose vitamin D following primary treatment of melanoma at high risk of recurrence: a placebo controlled randomised phase II trial Saw RP1, Thompson JF. ea Melanoma Institute Australia,North Sydney , Australia. .

  Indian Pediatr. 2014 ;51:265-72. 300,000 IU or 600,000 IU of oral vitamin D3 for treatment of nutritional rickets: a randomized controlled trial. Mittal , Gupta ea University College Medical Sci,, New Delhi.
Calcif Tissue Int. 2013 ;92(2):191-206. Is high dose vitamin D harmful? Sanders KM1, Nicholson GC, Ebeling PR., University of Melbourne

Med J Aust. 2005 Jul 4;183(1):10-2. Annual intramuscular injection of a megadose of cholecalciferol for treatment of vitamin D deficiency: efficacy and safety data. Diamond TH1, Ho KW, Rohl PG, Meerkin M.University of New South Wales, Australia.

Geriatr Orthop Surg Rehabil. 2011 May;2(3):94-9. . Improving mobility and reducing disability in older people through early high-dose vitamin d replacement following hip fracture: a protocol for a randomized controlled trial and economic evaluation. Mak JC1,  Cameron ID ea. , University of Sydney, Australia .Hypovitaminosis D is particularly common among older people with a proximal femoral (hip) fracture and has been linked with poorer lower extremity functioning, falls, and fractures.

     J Nutr. 2014;144:2002-8. Vitamin D deficiency is associated with progression of knee osteoarthritis. Zhang FF1, McAlindon TE EA2.usa uNIVERSITIES

    Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2014 ;28(14):1031-3. [Effect of nasal instillation of vitamin D3 on patient with allergic rhinitis symptoms]. [Article in Chinese] Gong, Jiang Y EA

      Nutrients. 2014 ;6(9):3403-30. doi: 10.3390/nu6093403. Does sufficient evidence exist to support a causal association between vitamin D status and cardiovascular disease risk? An assessment using Hill’s criteria for causality.Weyland PG1, Grant WB2, Howie-Esquivel J3., University of California,
Eur J Clin Nutr. 2014 ;68(5):632-4..Pharmacokinetics of daily versus monthly vitamin D3 supplementation in non-lactating women.Meekins ME1,, Thacher TD2Mayo Clinic, Rochester,& University of Witwatersrand, Johannesburg,
Mol Med. 2009 ;15(9-10):328-36. Vitamin D affords better neuroprotection against excitotoxicity in cultured cortical neurons than progesterone alone. Atif F1, Sayeed I, Ishrat T, Stein Emory University, Atlanta, Georgia, USA
.
Am J Clin Nutr. 2008 ;87(6):1952-8. Vitamin D intake to attain a desired serum 25-hydroxyvitamin D concentration. Aloia, Yeh ea Winthrop University Hospital, NY.
Am J Clin Nutr. 2008:87(3):688-91.Pharmacokinetics of a single, large dose of cholecalciferol.  Ilahi M1, Armas LA, Heaney Creighton University Omaha, .
Curr Opin Lipidol. 2007 ;18(1):41-6. Vitamin D and vascular calcification.Zittermann Schleithoff Koerfer Ruhr University Bochum, Germany.
J Am Coll Nutr. 2003 Apr;22(2):142-6. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. Heaney RP1, Dowell MS, Hale CA, Bendich A.Creighton University, USA.

         Diabetes Care. 2015 May. pii: dc150323. Effect of LOWDOSE Vitamin D Supplementation on Glycemic Control in Patients With Type 2 Diabetes (SUNNY Trial): A Randomized Placebo-Controlled Trial. Krul-Poel YH1, Simsek S7 eu .

          Horm Metab Res. 2015 May 4 Effects of High-Dose Vitamin D Supplementation on Metabolic Status and Pregnancy Outcomes in Pregnant Women at Risk for Pre-Eclampsia. Karamali M1, Asemi Z ea.
J Am Geriatr Soc. 2014 ;62(8):1546-50..Effectiveness and safety of a high-dose weekly vitamin D (20,000 IU) protocol in older adults living in residential care. Feldman F1, Green TJ.ea. Simon Fraser University, Burnaby, BC, Canada.

    Maturitas. 2015 Mar 27. Sarcopenia in post-menopausal women: Is there any role for vitamin D? Anagnostis P1, Goulis DG ea Greek Universities http://www.ncbi.nlm.nih.gov/pubmed/?term=aganostis+Sarcopenia
J Adolesc Health. 2015 Apr 11. Vitamin D =<2000iu/d Fail to Increase 25-Hydroxyvitamin D Levels or to Alter Cardiovascular Risk Factors in Obese Adolescents: A Pilot Study.
Shah S1, Wilson DM2, Bachrach LK2.

     Lancet Infect Dis. 2015 May;15(5):528-34.Adjunctive vitamin D 400 000iu in 6 weeks for treatment of active tuberculosis in India no benefit : a randomised, double-blind, placebo-controlled trial. Daley P1, Vieth R4, , Mathai D ea .
Thorax. 2015 May;70(5):451-7. doi: 10.1136/thoraxjnl-2014-206449. Epub 2015 Feb 27.
PLoS One. 2015 Feb 23;10(2):e0117123. doi: 10.1371/journal.pone.0117123. eCollection 2015. Vitamin D₃ supplementation in Batswana children and adults with HIV: a pilot double blind randomized controlled trial. Steenhoff AP1, Stallings ea .
Eur J Endocrinol. 2015 Mar;172(3):235-41. doi: 10.1530/EJE-14-0870.Vitamin D3 increases in abdominal subcutaneous fat tissue after supplementation with vitamin D3. Didriksen , Jorde R3 ea

44-9987.12279. Epub 2015 Feb 6. Effects of a single, high oral dose of 25-hydroxycholecalciferol on the mineral metabolism markers in hemodialysis patients. Merino , 2, Quereda ea, .
Pediatr Neurol. 2015 ;52:160-4.Vitamin D supplementation in children with epilepsy and intellectual disability. Snoeijen-Schouwenaars , Majoie MH ea .:.
J Acad Nutr Diet. 2015 Feb;115(2):225-30. .Dietary fat increases vitamin D-3 absorption.Dawson-Hughes B, Rasmussen H.
Eur J Clin Nutr. 2015 ;69(2):193-7 The effect of a single, large bolus of vitamin D 250,000 IU in healthy adults over the winter and following year: a randomized, double-blind, placebo-controlled trial.Kearns MD1, Tangpricha V3

.
Sleep Breath. 2015 May;19(2):579-83. doi: 10.1007/s11325-014-1049-y. Epub 2014 Aug 23. The effect of vitamin D supplements on the severity of restless legs syndrome. Wali S1, Krayem A.

Endocr Pract. 2014 ;20(12):1258-64..The vitamin d dose response in obesity.Dhaliwal R1, Aloia JF1.

BMC Infect Dis. 2013;13:22. Vitamin D accelerates clinical recovery from tuberculosis: Salahuddin N ea.
VIT D & INFANTILE BRONCHIOLITIS
Curr Drug Targets. 2011;12(4):489-500. Immunologic impact of nutrient depletion in chronic obstructive pulmonary disease. Herzog R1, Cunningham-Rundles , Cornell University, NY.

    Ital J Pediatr. 2014 Oct 24;40:65. Inter-society consensus document on treatment and prevention of bronchiolitis in newborns and infants. Baraldi , Corsello EA -Società Italiana per le Malattie Respiratorie Infantili, Italy. http://www.ncbi.nlm.nih.gov/pubmed/25344148
Pharmacol Ther. 2013;140(2):148-55.Vitamin D deficiency and severe asthma. Poon AH1, Mahboub B, Hamid Q. McGill University, http://www.ncbi.nlm.nih.gov/pubmed/?term=Vitamin+D+deficiency+and+severe+asthma.+++Poon+AH
Clin Exp Allergy. 2014 Feb;44(2):231-7. doi: 10.1111/cea.12247.Vitamin D-binding protein haplotype is associated with hospitalization for RSV bronchiolitis. Randolph, Bont EA Harvard Medical School.
Pediatr Pulmonol. 2014;49(8):790-9. Vitamin D receptor (VDR) polymorphisms and severe RSV bronchiolitis: a systematic review and meta-analysis. McNally1, Little ea. Univ Ottawa, Canada.
Pediatrics. 2011;127):e1513-20. Cord blood vitamin D deficiency is associated with respiratory syncytial virus bronchiolitis. Belderbos, Bont ea, University Utrecht,Ndl. http://www.ncbi.nlm.nih.gov/pubmed/?term=Cord+blood+vitamin+D+deficiency+is+associated+with+respiratory+syncytial+virus+bronchiolitis.+Belderbos

     J Matern Fetal Neonatal Med. 2013;26;639-46.Vitamin D and neonatal immune function. Clancy ea Ireland http://www.ncbi.nlm.nih.gov/pubmed/?term=Vitamin+D+and+neonatal+immune+function.
Nutr Rev. 2012;70:548-52. Better newborn vitamin D status lowers RSV-associated bronchiolitis in infants.Maxwell CS1, Carbone ET, Wood RJ. University of Massachusetts, Amherst, USA. http://www.ncbi.nlm.nih.gov/pubmed/?term=.+Better+newborn+vitamin+D+status+lowers+RSV-associated+bronchiolitis+in+infant
OVERDOSE
Am J Clin Nutr. 1999 ;69:842-56.Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Vieth.   University of Toronto, Canada.

     Clin Endocrinol (Oxf). 2015 Jun . doi: 10.1111/cen.12836. Vitamin D toxicity resulting from overzealous correction of vitamin D deficiency. Kaur, Mithal ea Delhi.

     J Steroid Biochem Mol Biol. 2015 Apr;148:14-8. Iatrogenic vitamin D toxicity in an infant–a case report and review of literature. Ketha, Singh EA

    Einstein (Sao Paulo). 2014;12(2):242-4. Vitamin D intoxication: case report.
[Article in English, Portuguese] Marins TA1, Korkes H1.ea Hospital Israelita Albert Einstein, São Paulo, Brazil.
J Clin Endocrinol Metab. 2011;96(12):3603-8. .Vitamin D intoxication with severe hypercalcemia due to manufacturing and labeling errors of two dietary supplements made in the United States.Araki T1, Holick MF, Newman LG.ea

Ann Pharmacother. 2011 ;45(10):e52. Hypervitaminosis D associated with a vitamin D dispensing error. 4.5million iu over 3 mo. Jacobsen , Schilling ea.

Am J Public Health. 1995 ;85(10):1418-22.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1615632/pdf/amjph00448-0092.pdf Subclinical health effects in a population exposed to excess vitamin D in milk. Scanlon, Falk H.ea
N Engl J Med. 1992 ;326(18):1173-7. Hypervitaminosis D associated with drinking milk. Jacobus CH1, Holick MF, Seely EW.:ea .

Q J Med. 1986 Oct;61(234):911-9. The osteodystrophy of hypervitaminosis D 365million iu over 10 years: a metabolic study. Davies M, Mawer EB, Freemont AJ. A patient received 2.5 mg vitamin D2 ie 100 000iu/d daily for 10 years ie 365 million iu total, presented with increasing skeletal pain and hypercalcaemia. The limbs were painful to touch especially at the insertions of ligaments and tendons, and radiographs showed osteosclerosis with calcification in the periosteum, blood vessels, tendoachilles and plantar fascia. A negative external calcium balance was documented in the presence of enhanced intestinal calcium absorption and an increase in urinary hydroxyproline excretion. Cortisone improved calcium balance and corrected the hypercalcaemia by reducing serum 1,25-dihydroxyvitamin D levels and urinary hydroxyproline excretion.

Nouv Presse Med. 1981;10(36):2965-7.[Vitamin D metabolites in a new case of drug-induced hypercalcemia (author’s transl)]. [ French] Ulmann A, Bourdeau A, Lair M, Bader C. the authors report on a new case of severe hypercalcaemia induced by prolonged oral treatment with high doses of vitamin D2. (6 mg ie 240 000iu/day ie for 9 months ie 23million iu).

     Lancet. 1978 ;2(8090):621-3. The continuing risk of vitamin-D intoxication.
Davies, Adams . Eight cases of vitamin-D poisoning are described.
.
Arch Intern Med. 1975 Jul;135(7):986-8. Protracted vitamin D intoxication.
Shetty , Hagen ea   A 56-year-old woman underwent subtotal thyroidectomy for Graves disease in 1963. After the operation, hypoparathyroidism developed and therapy was begun with vitamin D2 (ergocalciferol), 100,000 units daily.  Four months later, ie 12 million iu vit D, after hypercalcemia (14 mg/100 ml) had been noted, vitamin D therapy was discontinued

    Dtsch Med Wochenschr. 1975 ;100(9):415-6, 419-23. [Observations in vitamin D and dihydrotachysterol poisoning]. [German] Ziegler R, Delling ea. In three women intoxication with vitamin D or dihydrotachysterol occurred. Two patients died from complications despite successful lowering of the serum calcium, the third died after a pulmonary embolus during hypercalcaemia 5 months after cessation of vitamin D. .

    Br Med J. 1972 ;3(5820):205-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1785685/pdf/brmedj02214-0027.pdf Vitamin D intoxication treated with porcine calcitonin. Buckle RM, Gamlen TR, Pullen IM.Southampton UK Porcine calcitonin was used to treat three Southampton women in their sixties with hypercalcaemia due to accidental chronic vitamin D intoxication with 30 000 to 500 000iu/d for 4 to 13 weeks (vit D 9 million iu over 4wks; 4.5million iu over 13 week; and 29 million iu over 2 months). Normocalcaemia was achieved in 3 to seven days, with rapid full recovery.

FIGHTING INFECTION NATURALLY IN THE POST-ANTIBIOTIC ERA

FIGHTING INFECTION NATURALLY IN THE POST-ANTIBIOTIC ERA: SALUTE DR IGNAZ SEMMELWEIS

TRIBUTE:  to pioneer  Dr Ignaz Semmelweis martyred 150years ago by his jealous Viennese colleagues for shaming them by  saving  mothers’  lives with good hand hygiene- chlorine disinfection-  from childbirth fever  .

At no time in the past century of synthetics has natural infection control been more important; up to WW1 and the 1918-19 Influenza pandemic, infection killed more more armies of men than warfare itself.

Now  one  in three deaths in “western”  hospitals are  attributed to hospital-acquired antimicrobial  resistant bacterial (eg MRSA, MTB),  fungal  and now vital (eg HIV) infection;

and antivirals and vaccines anything but  eradicate serious HIV, flu, HSV, HPV, ebola, malaria, hepatitis, CMV,  etc.

Because of antibiotic harms, we increasingly have to advise patients against antibiotics for non-purulent respiratory- ENT, skin, gastrointestinal and genitourinary  infections since these are so often viral/ allergic.

But (apart from good hygiene),  given clean food, water and sanitation, the low-cost umbrella of proven safe natural immune boosters can at least halve infection rates, severity and thus deaths.

ph or email for appointments:  neil.burman@gmail.com; personal +27836299160.  fax+27865657215 Preferred provider contracted to major medical schemes.

Natural Medicine Clinic

1st floor, 15 Grove Bldg, Grove Ave, Claremont 7708. ph 021 6831465 office hours.

The Nonscience Witch Hunt Against HRT for Deficiency Syndromes Must End: An A4M Position Paper on Physician-Prescribed HRT

Our Oct 2014 cover
The Nonscience Witch Hunt Against Hormone Replacement Therapies for Deficiency Syndromes Must End
An A4M Position Paper on Physician-Prescribed HRT

Introduction  “Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an undercover dictatorship to restrict the art of healing to one class of Men and deny equal privileges to others; the Constitution of the Republic should make a Special privilege for medical freedoms as well as religious freedom.”~Benjamin Rush (1745–1813), physician, writer, educator,
humanitarian, and Founding Father of the US

Since the inception of the anti-aging medical movement in 1991, various establishment parties have ruthlessly leveraged their positions of power in academic, political, and regulatory arenas for the purpose of attempting to limit the use of hormone replacement therapies (HRT) in adults with documented clinical deficiencies. For over 15 years, a prolonged and calculated campaign of deceit, fraud, and suppression has threatened physician licensures and liberties to treat and prescribe life-improving therapies, leading potentially to the direct compromise of patients’ health and longevity. Dozens of physicians have been sanctioned and punished with loss of license and academic standing. This pernicious abuse of position and power is particularly prevalent with regard to recent challenges made against human growth hormone (HGH), testosterone (TRT), and DHEA replacement therapies that are trumpeted by the mainstream media. Biased reporters frequently – and inappropriately – demonize legitimate physicians and clinical compounding pharmacies that are reluctantly positioned on the frontline of a decades-old agenda to limit freedom of choice and information, and the physicians’ most essential responsibility to select the best course of therapy and medication for their patients.

This conflict is being played out of late in the arena of anti-aging medicine, a clinical specialty that has flourished in its 22 year long history, garnering the support of more than 100,000 physicians and scientists worldwide who practice or research life-enhancing, life-extending interventions today. Prof. Dr. Imre Zs.-Nagy, of the University of Debrecen Medical and Health Science Center (Hungary), and founder of the Archives of Gerontology and Geriatrics (published by Elsevier), observes: “In my role as a basic and clinical scientist, I have had an opportunity to witness more than four decades of advances and declines in the arena of preventive medical care … there has been little else as dramatic, important, beneficial, and significant as the anti-aging medical movement.”1
   
Continual vigilance is necessary to countermand those whose financial and professional successes depend on repeated, calculated attempts to discredit the science and substance of anti-aging medicine.
   
Remarks Tanjung Subrata, MD, of Udayana University School of Medicine (Indonesia):
Anyone who does not believe in evil is not paying attention to the recent affairs of the past twenty years. We are living in a time of unprecedented tribulation and changes at-large – and in health care, in particular. All that is necessary for evil to prevail is for men of good will to do nothing. In this modern age of zero tolerance for alternatives to establishment medicine, and the willingness of our governmental officials to resort to police state tactics to suppress innovative schools of thought, progress in medicine halts and dies.2

A4M Position
The American Academy of Anti-Aging Medicine (A4M), its numerous worldwide affiliated scientific and medical societies, and befriended organizations support the judicious application of modern and advanced medical technologies to address the changes in chemical, hormonal, physical, and nutritional needs that occur with aging. Such repletion includes the restoration of hormones to an optimal physiological state when deficiency is determined by objective assessment.
   
Hormone replacement therapy (HRT) is an essential and extensively documented protocol for clinical intervention in the disorders of aging. HRT maintains an unblemished safety and efficacy profile that has been documented by 20 years of clinical application. Yet, a perfect storm of misguided media, combined with biased parties whose livelihoods hinge on disparaging the anti-aging medical movement, has grossly compromised access to HRT, placing the lives of hundreds of thousands of patients worldwide in potential jeopardy.
   
Experienced anti-aging physicians have been prescribing HRT for more than 20 years. PubMed contains more than 20,000 peer-reviewed studies of HRT, of which a preponderance document the life-enhancing and/or life extending benefits of HRT in aging adults. See Appendix A “Literature Review,” which presents a selection of such studies that represent the objective evidence that supports the A4M position.

The Anti-Aging Medical Movement
The goal of anti-aging medicine is not to merely prolong the total years of an individual’s life, but to ensure that those years are enjoyed in a productive and vital fashion. As established in 1991 by the physicians of the American Academy of Anti-Aging Medicine (A4M), the field of anti-aging medicine developed as a direct extension to the science of elite sports medicine of the 1980s. Just as sports medicine aims to keep the athlete’s body functioning at its optimum level, anti-aging medicine seeks to keep the human physiology performing at its peak. In other words, the similar principle, of extending and maximizing the healthy human lifespan, is at the core of both anti-aging medicine and sports medicine.

The Official Definition of Anti-Aging Medicine
The clinical specialty of anti-aging medicine thus is defined as follows:      Anti-aging medicine is a clinical specialty is founded on the application of advanced scientific and medical technologies for the early detection, prevention, treatment, and reversal of age-related dysfunction, disorders, and diseases. It is a health-care model promoting innovative science and research to prolong the healthy lifespan in humans. As such, anti-aging medicine is based on principles of sound and responsible medical care that are consistent with those applied in other preventive health specialties. The phrase “anti-aging,” as such, relates to the application of advanced biomedical technologies focused on the early detection, prevention, and treatment of aging- related disease.

Anti-aging medicine utilizes diagnostic protocols that are supported by scientific evidence to arrive at an objective assessment upon which effective treatment is assigned. Physicians who dispense anti-aging medical care are concerned with the restoration of optimal functioning of the human body’s systems, organs, tissues, and cells. Attempting to rebrand what they cannot deny, those in positions of power in academic, political, and regulatory arenas are inventing new catchphrases including longevity medicine, successful aging, healthy aging, and the like, in an effort to dilute and absorb the A4M’s original definition of anti-aging medicine. To implement this campaign, we suspect that these individuals have pejoratively solicited major media outlets to denigrate the A4M, its officers, and its members.
   
Anti-aging medicine is, in essence, a euphemism for early detection and advanced preventative medicine. It is a health-care model that emphasizes personalized, patient-focused, high-quality metabolic-specific medical care.

Critics with A Dark Agenda (Political Elites)
Scientifically based and well documented in leading medical journals, anti-aging medicine is among the fastest-growing medical specialties throughout the world. As an innovative model for advanced preventive health care that cannot be denied, anti-aging medicine has been disparaged by individuals with their own political and financial agendas in attempts to restore monopolistic control over the field of aging intervention. Critics of the science of anti-aging medicine most commonly hail from academia: as such, these naysayers many times have little or no medical training in aging intervention and may be nonclinicians.
   
Perhaps the most inconceivable reality is that at the very highest levels of academia, government, and science, truth and objective scientific method are not at all sacred to the political elites. We in clinical medicine via our training, discipline, and conditioning naively believe and act in the public interest, for the good of our patients’ health, and by professional standards of medical ethics. The (elite) medical establishment operates contrary to this position, reports investigative reporter Tim Bolen (www.bolenreport.com), who for 30 years has amassed data and evidence exposing a calculated effort to deride innovative medical therapeutics. Bolen observes:  Without a doubt, a stealthy control group – a cabal, if you will, in status-quo medicine exists. Approved by Big Pharma, parts of academia, and segments of the government, this group exerts its control in many different ways. I have uncovered information showing anonymous, and not-so-anonymous, funding of groups, loosely describing themselves as “Quackbusters or Skeptics” whose only purpose is to attack cutting-edge health care offerings. Those groups, in turn, train, and fund sub-groups. Data suggests that the “Quackbusters or Skeptics” donated over $1 Million US to Wikipedia to purchase control over pages with medical content. More, the Skeptic training camps teach their recruits how to operate together to control that same Wikipedia and Search Engines. Further, these covert groups drive media on issues particularly pertaining to alternative health care, in an effort to limit coverage of innovative discoveries and to vilify therapies that are not part of AMA/FDA/Big Pharma establishment medicine health care.

There are TWO main “skeptic” organizations – the James Randi Educational Foundation (JREF) and the Center For Inquiry (CFI). Both are well funded from secret sources.

JREF reported, in 2010, a total income of $999,971.00 and a Total Asset claim of $1,736,101.

The Center For Inquiry, Inc (CFI), based in Amherst, New York shows on their Form 990 that they took in $5,242,304 in Total 2009 Income, and they had, that year, Total Assets of $3,017,144. Their Schedule B ANONYMOUS contributions totaled $2,318,652.

More, CFI claimed that they received, in 2009, in addition to their anonymous contributions, a so-called “Management Fee Income” of $2,458,156. What do you suppose they managed? And who paid them to manage it? Maybe they manage Wikipedia health care articles? How about Search Engine Optimization (SEO) bringing skeptic, including Stephen Barrett’s (Quackwatch), articles to the first page of Google?

Much more – This cabal minimizes and delays innovative medical advancements by lodging anonymous complaints to state licensing boards against cutting-edge practitioners. Their insidious campaign also controls grant monies and research funding, somewhat silencing the voices of innovative medicine in favor of mainstream views. By leveraging control of the media in direct jeopardy of journalistic integrity, this control group seeks to suppress all in medicine that is not fully controlled by the establishment. To permit this level of manipulation and disinformation is wrong and ethically corrupt. The fate of a valuable avenue of medical innovation for the public interest – anti-aging medicine – stands at-risk.3

A JAMA commentary purported to address the legality of human growth hormone (HGH, GH) treatment by physicians for growth–hormone deficient (GHD) patients.4 It is the view of A4M that the commentary contained a number of incorrect, misplaced references and studies, and multiple basic scientific errors, in an apparent attempt to damage the anti-aging medical profession and the physicians practicing solid, evidence-based medical health care focused on improving and maintaining patients’ quality of life. It is A4M’s further opinion that the authors selected self-serving studies, in which they failed to qualify the conclusions in an effort to bolster what A4M believes is a disinformation campaign. It is A4M’s opinion, for example, that they incorrectly intermingled Internet sales of homeopathic pseudo-“GH” sprays, amino acids, and sports nutritional over-the-counter products in order to inflate their incorrect claims suggesting an illegal diversion of HGH by physicians and pharmacies, implying a black market in FDA-approved prescription injectable HGH for hormone replacement treatments by anti-aging physicians where none exists.

Misrepresentation in Competitive Sports
As an unfortunate consequence of media confusion and outright deception aiming to deliberately misrepresent anti-aging medical care, the reality of the clinical practice of hormone replacement therapy has become muddled. A recent Sports Illustrated article states: “In the sports world, the term ‘anti-aging’ has often come to signify therapy that uses hormones – usually testosterone and HGH – and … DHEA.”5 This erroneous definition grossly misrepresents the legal and ethical physiological use of hormones and supplements as being synonymous with the inappropriate use of hormones for sports enhancement. The A4M is squarely opposed to this myopic interpretation of “anti-aging” and urges reference to the official definition of anti-aging medicine as presented above.

Page 1, 2, 3, 4, Appendix/Notes

UPDATE: LEGISLATING REDUCED ADVERSE FOOD ADDITIVES, MANDATING ADDED MICRONUTRIENTS

  The  Mail and Guardian Health supplement (11 April 2013)  featured the dynamic South African Health Minister   Dr Aron Matsoaledi legislating lower salt -sodium chloride-  in staple processed foods  eg in cereals, butter, potato crisps,     by about half  over the next 6 years.
         This is long overdue since salt-related hypertension and often associated.  obesity are  historically  major killers not just in Afro-Americans  but in any longer-living people and especially stressed poverty-stricken  peoples as in Africa.

The linked bad nutritional -and lifestyle – choices – Salt-Stroke  – smoking- – hypertension- obesity – diabetes – heart – kidney disease – are  quoted by S.A. Stats  2010 from death certifications as rising  to 24%  of deaths after age 50 years, leading even infections at  20%  as the commonest causes  of  seniors’ death in South Africa. Nonnatural causes ie violence account for only 5%, and cancers only about 4%.

           This in a population that ( both by self- choice and by State- and supply-chain corporates)   heavily self-poisons with industry-promoted salt,  concentrated   fructose-   sucrose, ethanol , unsafe sex, and smoking –  the deadly self-abuse quintet  causing the great majority of premature deaths and  disability – diabesity- brain-heart-vascular-renal-cancer -arthritis, infections, Alzheimers(type 3 diabetes) and violence. – ie the team of  high-profit horsemen (alcohol, smoking, sugar, fructose, salt and other addictive drugs; television, sex, guns, knives, fast motoring, and ruthless medical practices)  of the global marketting corporates .
          But not a word was  said in those two salty  pages  about simultaneously legislating for  processed consumables  the other greatly needed adjustments:
REMOVING from the environment, from  consumables (water and processed food , toothpaste, sweetened  drinks and sweeteners, baby milk formulae, hygiene products, vaccines, etc,)  or at least steadily reducing, other notorious and unnecessary  toxic  marketed hazards- aluminium, aspartame + sucralose, mercury, fluoride, bromine, refined sugars, cooked fats, and pesticides, hormones, antibiotics, and estrogenics eg soya ( unless fermented) used in food, medicine,  and vaccines ; and REPLACING in processed foods commonly and increasingly deficient  micronutrients in the regional diet especially for the poor masses and children – eg minerals (magnesium, calmag phosphate, zinc, iodine, lithium,  selenium,  sulphur, boron); vitamins (especially A, B, C, D3, K2, coQ10; and other crucial  essential  antiinflammatory  antioxidant  anti-obesity insulin sensitizers eg virgin coldpressed  coconut oil and uncooked marine omega3.
      From scientific studies there is little doubt that hypertension is proportionate to sodium chloride overload, as it  is especially to deficiency of magnesium, potassium, iodine, water, and vits  B, C, D3 and K2.  But scientific evidence is still unclear as to whether it is just the excess  essential halogen mineral CHLORINE.  in NaCl that  is the dietary cause of  hypertension,  not SODIUM in NaCl- but not in other essential forms eg with carbonate.
HALOGENS  in nature are the four major  elements – fluorine, chlorine, bromine and iodine from the lightest, ie lowest atomic number,  upwards.  Fluorine as  the lightest  is one of the most reactive ie corrosive of all materials. Halogens with metals eg sodium form sea- salts. As their weight/atomic number rises, they become less reactive,   Apart from  bromine they are disinfectants.
 IODINE is certainly  the heaviest and thus least reactive halogen iodine is the  essential  mineral that in adequate intake is  major anti infection- (among the strongest antimicrobials we have)-  anticancer, healer, thyroid metabolism and thus heart regulator, and major chelator – detoxifier- against the lighter  halogens – the toxic bromine and fluorine, and excess chlorine.
 The food and drug industry needs cudgeling to stop polluting water, medicines and food with unhealthy fluorine, chlorine and bromine.
FLUORINE is still misguidedly used , promoted in drinking water , toothpaste and antibiotics ; while  for obscure reasons BROMINE.  has replaced iodine in eg bread. FLUOROSIS and BROMaiSM  are notorious poisonings – and unlike iodine and chlorine,  the fluorine and bromine have no human essential  biological benefit as even trace elements. Fluorine – like aluminium, bromine, cadmium, mercury, iron, – may be invaluable in industry, but Fluorine is not essential for mammals or humans. Its use in dentistry has with mercury amalgams long been scientifically debunked as harmful and unnecessary, and is being phased out by preventative dentists everywhere. .
         Tricyclics and other pre-1980s antidepressants had several side effects due to their nonselective interference with neurotransmitters other than the serotonin target; the fluorinated fluoxetine was selective and one of the first avoiding this problem. but the serotonin deficiency hypothesis has never been proven to be a major factor in depression.  Many current antidepressants receive this same treatment, including the selective serotonin reuptake inhibitors citalopram But antidepressants have major adverse effects, are rarely as good as talk therapy, and often do  worse than natural mood-improving nutrients eg vitamins and fish oil.
Quinolones are artificial antibiotics often fluorinated to enhance their effects,eg ciprofloxacin. But these antibiotics are notorious for terrible advese effects including crippling weakening  – rupture of tendons, and are never essential. 
 BROMINE. Africa.   is still listed as a food supplier to the baking industry in South Africa!    But Wiki writes: bromine has no proven essential function or need in humans. an unwanted side effect is ozone depletion. As a result, many organobromide compounds that were formerly in common use—such as the pesticide, methyl bromide—have been abandoned. It reacts vigorously with metals, especially in the presence of water, to give bromide salts. It bonds easily with many elements and has a strong bleaching action. Like chlorine, bromine was used as a wartime poison gas, and disinfectant / pesticide- ie a poison! so bromines were removed from medical/vet use in the 1970s. Long-term use of potassium bromide (or any bromide salt) can lead to bromism. Yet it is used in: production of brominated vegetable oil, which is used as an emulsifier in many citrus-flavored soft drinks (for example, Mountain Dew). After the introduction in the 1940s the compound was extensively used until the UK and the US limited its use in the mid 1970s and alternative emulsifiers were developed. But .Soft drinks containing brominated vegetable oil are still sold in the US (2013).  Bromine, like chlorine, is used in maintenance of swimming pools, Water purification compounds, disinfectantsinsecticides, and photographic processes. .
        Dr Joe Mercola wrote in the Huffington Post 2010: “Bromines are common endocrine disruptors. What makes it so dangerous is that it competes for the same receptors that are used to capture iodine. If you are exposed to a lot of bromine, your body will not hold on to the iodine that it needs. And iodine affects every tissue in your body — not just your thyroid.  You are already exposed to far too much chlorine and bromine. Bromine can be found in a number of places in your everyday world, including: plastics, Bakery goods and some flours often contain a “dough conditioner” called potassium bromate; •Soft drinks (including Mountain Dew, Gatorade, Sun Drop, Squirt, Fresca and other citrus-flavored sodas), in the form of brominated vegetable oils (BVOs); Medications such as Atrovent Inhaler, Atrovent Nasal Spray, Pro-Banthine (for ulcers), and anesthesia agents; Fire retardants (common one is polybromo diphenyl ethers or PBDEs) used in fabrics, carpets, upholstery, and mattresses       According to van Leeuwen, who has extensively studied the effects of sodium bromide on thyroid function:   “Although the bromide ion is widely distributed in nature, the main route of exposure in humans stems from bromide residues in food commodities as a result of the abundant use of bromide-containing pesticides, like methylbromide and ethylene dibromide, for soil fumigation in intensive horticulture and for postharvest treatment.”      One clinical consequence of overexposure to bromine is suppression of your thyroid, leading to hypothyroidism, .
         
   Another is bromide toxicity: .Bromine — The Bully of the Halide Group:  When you ingest or absorb bromine, it displaces iodine, and this iodine deficiency leads to an increased risk for cancer of the breast, thyroid gland, ovary and prostate — cancers that we see at alarmingly high rates today. This phenomenon is significant enough to have been given its own name — the Bromide Dominance Theory.   Aside from its effects on your endocrine glands, bromine is toxic in and of itself. Bromide builds up in your central nervous system and results in many problems. It is a central nervous system depressant and can trigger a number of psychological symptoms such as acute paranoia and other psychotic symptoms.  In fact, in an audio interview, physician Jorge Flechas reported that, between 1920 and 1960, at least 20 percent of all hospital admissions for “acute paranoid schizophrenia” were a result of ingesting bromine-containing products. In addition to psychiatric problems, bromine toxicity  eg from the old BromoSelzer can manifest as the following: Skin rashes and severe acne; Loss of appetite and abdominal pain; Fatigue; Metallic taste; Cardiac arrhythmias. . These effervescent granules, developed by the Emerson Drug Company of Baltimore, were used to treat heartburn, upset stomach, indigestion, headaches and hangovers. Bromides were withdrawn from the American market in 1975 due to their toxicity.  Bromo-Selzer still  on the market  no longer contains bromide.                                                                                                                   
       
          Bromines in Your Bread Box: Potassium Bromate:  The ban on bromines have not prevented them from sneaking into your foods and personal care products.  You probably are not aware of this, but nearly every time you eat bread in a restaurant or consume a hamburger or hotdog bun you are consuming bromide, as it is commonly used in flours.  The use of potassium bromate as an additive to commercial breads and baked goods has been a huge contributor to bromide overload in Western cultures.  Bromated flour is “enriched” with potassium bromate. Commercial baking companies claim it makes the dough more elastic and better able to stand up to bread hooks. However , successful companies manage to use only unbromated flour without any of these so-called “structural problems.”  Potassium bromate is also found in some toothpastes and mouthwashes, where it’s added as an antiseptic and astringent. It has been found to cause bleeding and inflammation of gums in people using these products. Mountain Dew, one of the worst beverages you can drink, uses brominated vegetable oil as an emulsifier. Not only that, it contains high fructose corn syrup, sodium benzoate, more than 55 mg of caffeine per 12 ounce can, and Yellow Dye #5 (tartrazine, which has been banned in Norway, Austria and Germany.)  A weapon of mass destruction — in a can.   .Even drinking water can be a source of bromide. When drinking water containing bromide is exposed to ozone, bromate ions are formed, which are powerful oxidans.
   Sodium bromate can also be found in personal care products such as permanent waves, hair dyes, and textile dyes. Benzalkonium is used as a preservative in some cosmetics.    Finally, bromine and chlorine were the most common toxic elements reportedly found in automobiles, according to  David Brownstein, MD (March 2007). They showed up in the seats, armrests, door trim, shift knobs and other areas of the car.  The United States is quite behind in putting an end to the egregious practice of allowing bromine chemicals in your foods. In 1990, the United Kingdom banned bromate in bread. In 1994, Canada did the same. Brazil recently outlawed bromide in flour products.    Iodine Levels and Cancer Risk:  Iodine levels have significantly dropped due to bromine exposure; declining consumption of iodized salt, eggs, fish, and sea vegetables; and soil depletion. In the U.S. population, there was a 50 percent reduction in urinary iodine excretion between 1970 and 1990. What’s this doing to our country’s health?   The Japanese consume 89 times more iodine than Americans due to their daily consumption of sea vegetables, and they have reduced rates of many chronic diseases, including the lowest rates of cancer in the world.
            The RDA for iodine in the U.S. is a meager  0.15 mg/day, which pales in comparison with the average daily intake of 13.8 mg/day for the Japanese.  There is a large body of evidence suggesting that low cancer rates in Japan are a result of their substantially higher iodine levels. Iodine has documented antioxidant and anti-proliferative properties.   A strong case can be made that your iodine RDA should be closer to what the Japanese consume daily, if breast cancer rates are any indication. Low iodine can lead to fibrocystic breast disease in women (density, lumps and bumps), hyperplasia, and atypical mammary tissue. Such fibrocystic changes in breast tissue have been shown to reverse in the presence of iodine supplementation after 3-4 months.   If youwant to be tested  for iodine deficiency, the urine iodine challenge test is the best way to assess your iodine level.
              Bromine and Your Thyroid   Adding to the negative health effects of bromine, the damage to your thyroid health deserves special mention. bromine exposure depletes your body’s iodine by competing with iodine receptors. Iodine is crucial for thyroid function. Without iodine, your thyroid gland would be completely unable to produce thyroid hormone. Even the names of the different forms of thyroid hormone reflect the number of iodine molecules attached — T4 has four attached iodine molecules, and T3 (the most biologically active form of the hormone) has three–showing what an important part iodine plays in thyroid biochemistry.   Hypothyroidism is far more prevalent than once thought in the U.S. The latest estimates are that 13 million Americans have hypothyroidism, but the actual numbers are probably higher. Some experts claim that 10 to 40 %  of Americans have suboptimal thyroid function.   Many of these folks may actually have nothing wrong with their thyroid gland at all — they may just be suffering from iodine deficiency.
        Seven Tips for Avoiding Bromine and Optimizing Iodine   Trying to avoid bromine is like trying to avoid air pollution — all you can do is minimize your exposure. That said, here are a few things you can do to minimize your risk:
       1. Eat organic as often as possible. Wash all produce thoroughly. This will minimize your pesticide exposure. 2. Avoid eating or drinking from (or storing food and water in) plastic containers. Use glass and safe ceramic vessels.
        3. Look for organic whole-grain breads and flour. Grind you own grain, if possible. Look for the “no bromine” or “bromine-free” label on commercial baked goods. 4. Avoid sodas. Drink natural, filtered water instead.          .
         5. If you own a hot tub, look into an ozone purification system. Such systems make it possible to keep the water clean with minimal chemical treatments. 6. Look for personal care products that are as chemical-free as possible. Remember — anything going on you, goes in you,                                                                                          
        . 7. When in a car or a building, open windows as often as possible, preferably on opposing sides of the space for cross ventilation. Utilize fans to circulate the air. Chemical pollutants are much higher inside buildings (and cars) than outside.
           Avoid Unfermented Soy Another major contributor to thyroid dysfunction that I did not discuss above is unfermented soy. Soy isoflavones – estrogenics- can wreak havoc on your thyroid. Kaayla Daniel’s groundbreaking book, The Whole Soy Story: The Dark Side of America’s Favorite Health Food is a powerful exposé that reveals the truth about the soy myths that have infiltrated our culture. So if you want to keep your thyroid healthy, you’ll definitely want to avoid bromines, and unfermented soy products of all kinds, including soy milk.”
               These changes  – removing fluoride, bromine, aluminum, mercury, lead, unfermented soy-  from consumables, and cutting added iron and chlorine – may possibly add fractional cost to production?  but will hugely improve educability and health, productivity and employability, and reduce premature disability and death  far more than just  hypertension- vascular risks;  and greatly reduce acute and chronic illness and infections, hospitalization and need for risky modern  chronic prescription medication..  And since iodine deficiency is widely endemic ,  increasing population iodine intake up to 12mg a day  like Japanese get,  – not 0.15 mg/ d – will  hugely reduce premature aging,  common goiter and hypothyroidism, infections, vascular disease  and cancer
But of course Corporates, Governments and the Disease , Drug and Hospital Industries  dont want disease ,  jobs and profits to be decimated by natural supplements avoiding most common diseases- the Fraud of Modern Medicine since Only Disease Pays.

COMBATTING THE INCREASING OCCURRENCE OF BREAST CANCER IN YOUNGER WOMEN.

UPDATE: 2 Mar  2014: PARACETAMOL ACETAMINOPHEN, DIGOXIN AND SPIRACTIN are ESTROGENIC: even the most popular and perhaps safest synthetic designer painkiller paracetamol acetaminophen (Tylenol, Panado) discovered in 1877   has again been shown  (Harvard University 2014- the Nurses’ Health Study from 20 years ago) to be ( like the 250year old biological human hormone digitalis/digoxin, and the 50year old synthetic antihormone  spironolactone), a weak estrogenic ie they proliferate the breasts and thus cancer potential.                       Acetaminophen use was positively associated with total Estrogen Metabolites (2+ days/week vs. non-use: 236 vs. 198 pmol/mg creatinine; p difference = 0.02, p trend = 0.11),  Thus like its cousin phenacetin (never mind alcohol and smoking)  after decades of fraudulent promotion as safe,  paracetamol’s harms outweigh its utility

     Thus while it  is fairly safe in adults in moderation,  like all designer synthetic drugs eg NSAIDs and synthetic/xenohormones,  like even lowdose aspirin, paracetamol  has many risks (even for the eyes)  and doesnt cure anything- whereas digoxin and spiractin may have lifesaving benefits in serious heart/ hypertensive disease. .

As always, for pain best stick to physical cure by eg manipulation, massage, rest and exercise, heat or cold, acupuncture; or some natural safe biological analgesic/antipyretic combination– massage with   arnica/menthol/coconut oil/ DMSO/cayenne/Lugol’s iodine/magnesium oil;     or these orally with eg fish oil; vitamins C (eg citrus), D3 (sunshine) and B esp B5 (meat, whole grain, avocado, brassica);  magnesium, manganese, copper, iodine, selenium; GABA (but not gabapentin and pregabalin – Bad Medicine);  plant extracts eg  boswelia, bromelain, buchu,  catsclaw, curcumin, dandelion,  MSM, nettle, ginger, caffeine, ecchinacea, sage, cherries, Oregano, rosemary, thyme, mint, cannabis, angelica, valerian;  and  cartilage eg glucosamine-chondroitin .

Oct 2013:  BREAST PAIN,  CHEST PAIN AND HORMONE CONTRACEPTION.

CHEST/BREAST  PAIN: In men and women, nontraumatic pain in the front , back and sides  of the chest (and abdomen)  is mostly neuromusculoskeletal, and easily diagnosed  by  the history (absence of cough, central deep pain radiating especially to the jaw , back  or left shoulder, breathlessness, fever, heartburn),  and  physical examination –absence of  systemic signs or  significant  changes in pulse and bloodpressure);

and appropriate assessment of the neck and thoracic spine since these are so often where root pain (around the shoulder girdle, trunk and limbs)  originates and can be simply relieved ie cured and thus diagnosed.

    This is crucial in daily busy  primary care ie general practice where patients –especially the younger fitter ones without the common high  risks – want a quick opinion and fix so they can move on, not have to undergo xrays,  heart-  and blood-tests that specialists and hospitals, medical schemes, politicians and civil servants  thrive on..

    Older women of  course  usually have the   major extra anterior chest organs – pendulous  breasts – to  consider.  But the same  history and physical exam as in men  quickly mostly  sorts out the source and thus the cause of the pain:  a mammary cause eg hormonal congestion diffuse tenderness,  discharge, or tender  lump or gland, or root cause, is  quickly  apparent.

CASE REPORTS: at yesterday’s breast clinic we saw the usual spread of middle-age issues  in the eight  (mean age 45yrs, 32 to 65yrs) who booked  for breast prescreening imaging :

HORMONE CONTRACEPTION vs NECESSARY (PRO)HORMONE SUPPLEMENTS:

TWO IN THEIR FORTIES  ON DEPOT PROGESTINS:

CHEST PAIN: clerk Ms  booked herself for screening with almost constant  discomfort in her left breast for about 10weeks.. Like her and her doctors’ examinations, mammography a  month earlier found nothing abnormal.. She had no history of trauma or pain elsewhere, just slight neck discomfort. Her last period was years earlier, still on contraception  progestin injections. Examination and  mechanical tactile breast imaging confirmed tender full breasts; with maximal palpation tenderness midthorax laterally  at the site of her complaint.          Pressure and rotation elicited no discomfort elsewhere.  Gentle traction manipulation of her neck halved the ‘breast’ discomfort, which disappeared with a final satisfying click with gentle prone rotational pressure on her appropriate upper thoracic vertebra – confirming the root  source of her pain had been cured; and obviated further concern , tests and  analgesia.

 Manageress  also on  longterm depot hormone contraception (Mirena), with growing breasts,    rising weight despite careful diet,   and  concern about hip osteoporosis on DXA screening that was not improving but worsening the past 3 years on some routine vitamins C, D3  2000iu/day. K2 and calcium supplements. Her husband (not she) observed that she had severe night sweats.

       Both of the  ladies on synthetic progestin contraception   were reminded that such depot synthetics  suppress the ovaries ie cause artificial menopause with all its longterm subtle adverse effects, and that such hormones are known to slightly increase the risk of breast cancer, fattening and osteoporosis.    Both   were recommended progesterone cream, vitamin D and metformin as well as the other almost 20 bone supplements, for (pro)hormone balance and to assist with body fat  and thus all-risk reduction

        Ms   mid-60s with no complaints except stress vertebral fracture from osteoporosis now on opioid patch!  mother died of breast cancer at 78yrs; she has had 10 mammograms;  just dense lumpy breasts;; advised vigorous vit D, Super C, K2; Triple Bone-Pain – antiarthritic blend; metformin; DHEA and melatonin 20mg/d;

    Ms  early  50s  with menopausal symptoms, hypertension ( on perindopril)   and lumpy breasts, now off Nuristerate, ,   was advised to take appropriate supplements including progesterone cream. There is a new report from Holmes ea Canada http://www.ncbi.nlm.nih.gov/pubmed/24075077  that ACEi/ARBs use eg perindopril  was associated with significant 22%  increased deaths from  breast cancer (95% CI: 1.04-1.44), let alone the risk with such drugs of recurrent persistent cough and insidious nephropathy; so is advised to swop over to the safest best and cheapest 1st-line antihypertensive regime of lowdose  reserpine with low dose amilozide,

Ms  mid-30s with a child despite endometriosis and  PCOS , 4 years after removal of Mirena (7 years) , had lumpy breasts. Advised metformin,  vits  D and Supervit C, minerals and vitamins.

Ms  early 30s with PCOS , two aunts in their 50s with breast  cancer, her granny from the other parent having died of breast cancer at 76years.. with  lumpy breasts; she was advised the supplements including progesterone cream, melatonin, and metformin.

TWO IN THEIR 30S HAD KNOWN BREAST CANCER:

 Ms   mastectomy and DXRT 2011, now off Nuristerate ,  given weeks to live 18 mo ago with brain metastases that have shrunk with chemoradiotherapy and her zealous work as a cancer counselor;  lumpy other breast; now advised metformin, sutherlandia, melatonin 20mg/d,  vigorous vit  K2,  D and Supervit C, DIM, mushroom, astragulus, selenium, minerals and vitamins within her means.

Ms   had lumpectomy and 3 positive glands/12 removed in 2011, refused further oncology/ radiochemotherapy.   Lumpy breasts confirmed . Advised metformin,  sutherlandia, melatonin 20mg/d,  vigorous vits K2,  D and Supervit C, DIM- I3C, mushroom, astragulus , selenium, minerals and vitamins;  if not Iscador, cesium, TCM,  and pancreas/gene therapy  within her means.

BREAST PREVENTION REGIME: apart from optimizing diet and lifestyle with appropriate obesity-reducing diet and avoidance of estrogenic foods and drugs,

Based on published evidence and our experience from patients of analgesics and anticancer benefit, all were advised to try  triple breast massage daily with coconut oil, Lugols iodine then DMSO  for a few weeks, and if they want reassurance, return in a month or two  for followup breast imaging to show the shrinkage in all lumps that  most show. Those with higher risks are advised to take the oils by mouth as well, and if iodine depleted, oral iodine , for their global benefits.

      However, short of  avoiding  sex, or use condoms and barrier creams, or ill-advised sterilization or dependence on coitus interruptus,  their contraceptive method is hard to improve, short of relying on the oldfashioned intrauterine device without any contraceptive hormone. The oldest naturally occurring pregnancy we have seen was at 55 years, so women have to take care past this age…Natural human contraception with depot human progesterone and estrogen was developed decades ago, but naturally not made available commercially because only synthetics are patentable and thus commercially viable raincheck drugs that profit Big Pharma, health professionals and politicians. .

     Instead, women are advised simply to protect the breasts, womb, brain, heart, skeleton,  face etc, and stop menopause symptoms, by adding just enough human  progesterone cream daily to their face makeup (+- vaginally); (testosterone cream sparingly  if indicated for frailty, depression  and poor sex) , and take a sensible daily blend of the twenty other natural bone and multisystem antioxidant anabolics  (as this website www.healthspanlife.wordpress.com details under osteoporosis) including vitamin D about 2500iu/kg/month ie about 150 000 to 200 000 iu/month for an average size adult.

         In people rapidly fattening due to lifestyle, stress and the bad marketed adverse food chain, wiser choices have to be promoted-which does not suit most  politicians, Big Business or the Disease Industry for whom Only Disease Pays-  Prevention Doesn’t Pay.. So to protect against fattening and insulin resistance perils, metformin to sensible tolerance is also an inevitable recommended  natural albeit prescription supplement until healthy robust lean weight can be maintained without it.

      The supplements listed  above – (fish oil, appropriate parenteral human sexhormone replacement and the other antioxidants/anabolic vitamins, minerals and natural biologicals including the prohormones metformin and vitamin D) also mostly obviate the deplorable high-risk use (for commercial profiteering) of risky synthetics eg  statins, bisphosphonates, psychotropes, analgesics, NSAIDS, patented xenohormones and chemotherapy   etc – none  of  which address the underlying stress, deficiency  and pollution ie primary causes of  disease.

UPDATE: FIGHTING THE TIDE  OF  BREAST CANCER, DISEASE  in YOUNGER WOMEN: 

16 June 2013 A new review by Carolanne Wright reviews how to combat estrogen overload – How environment and lifestyle contribute to hormonal imbalance while devastating the health of both men and women.

27 May 2013 Wikipedia reports that in 2008,  about half a million women   died from  breast cancers (out of some billion older women worldwide ie 0.5 per 1000 women, an annual deathrate of 0.05% pa),  23% of cancer deaths in women; with cancer overall accounting for about 13% of deaths -the commonest being stomach-colon-liver 2.8%;  lung cancer 1.4%, then breast 0.46%  of deaths. So breast cancer – mostly undetected globally  by the luxury of mammography till it presents clinically-  kills only perhaps  1:2000 older women per year, ie perhaps <25%  of the  perhaps  1:500 older women who develop clinical breast cancer-  995/1000 of older women’s deaths being from other causes than breast cancer.

These figures dispel the  dangerously fraudulent  fearmongering  lie  of the USA Radiological and Breast Cancer Associations and Curves International that “(screening) mammography saves lives”. Its good to see in the current Curves South Africa website that in this Celebrating Mothers’ Week at Curves, they have dropped the Mammography saving lives myth of 3 years ago that started this particular theme column.  That hasnt stopped USA doctors  from continuing to propogate the lie.

But some there  eg Dr Lissa Rankin MD – daughter of a mammography radiologist- are still brave enough to refute the lie. And even the American Cancer Society chief medical officer doesnt make such ludicrous  claims but points out how complex the issue of prescreening detection is. .

Johnson and Bleyer reported Feb 2013    from the SEER study  that advanced breast cancer in young USA  women 25-39yrs has doubled between 1976 and 2010.

South Africa (religion mostly African Christian) has the distinction  of being one of Earth’s  most corrupt and illiterate  countries,  with strange bedfellows –  Latin  America (mostly Catholic),  Egypt Lebanon & Pakistan(Islamic), and  South Korea(mixed religions)-  that follow the USA in defying evidence – in this case  of danger to cows and humans – and allow the use of rBGH recombinant Bovine Growth Hormone ; and  sex hormones   in dairy and meat production. The evidence of harm, eg  carcinogenicity and feminization  is so strong that such  use has been banned in many  countries for decades .

MORTALITY TREND AND CANCER IN RSA AND GLOBALLY: Breast cancer is usually a disease of postmenopausal women-who till a centry ago on average barely lived to that age. In South Africa at the   peak of the untreated AIDS epidemic around 2000, with average lifespan drastically fallen, of all deaths, overall infections (HIV  TB, pneumonias etc)  caused about 39%, external causes  12%, cardio/vascular disease 11%,  cervix cancer 1.4% and breast cancer 1.3%.    But Statistics SA report last month that by 2010, with antiretrovirals, life expectancy  had risen about 5years, and that of all deaths,  HIV+TB  deaths had  at least halved   to  15% (17% in Africans, 9% in coloureds, 2.4% in Indians), cardio/vascular deaths were 12% in blacks but 27.8% in whites; external causes down to 9%, cancers 9% (mostly digestive and respiratory); with only 20 breast cancer deaths ie 0.00% reported in RSA.

Breast cancer is still rare in a mostly young population with mean age of survival of women still half of that of the first world,  with virtually a generation gap due to the carnage of the untreated AIDS era and institutionalized male violence especially against women, children and minorities- xenophobia.

But meat  and dairy milk (in South Africa widely containing added rBGH and sex hormones) are  among widely used foodstuffs likely contributing, as Joe Mercola notes,  to the increasing occurrence of breast cancer in younger women. Never mind deadly  sugars, smoking and alcohol consumption on the rise here in RSA.

AVOIDING CANCER AND MASTECTOMY:
To   improve immunity,  insulin receptor sensitivity
,  lessen obesity and excessive estrogenization (from both outside your body,  and your own fat production):

  • Exercise;  Maintain a healthy body weight  -BMI < 24kg; waist girth<about 85- 90 cm; earthing- walk barefoot.
  •    AVOID:- added or concenrated sugar, (especially fructose- commercial fruitjuice; cornstarch, white flour); charred fats; smoking; alcohol;  unfermented soy products; licorice; GE genetically engineered foods. .  
  • BUT those with asthma, leaky gut/IBD, epilepsy or bad arthritis should also try excluding for a few weeks WHEAT; DAIRY; AND NIGHTSHADEs (potato, tomato, peppers/cayenne, eggplant).
  •              —synthetic sexhormones (progestins, xenoestrogens eg in meat, commercial milk, birth control and HRT,   BPA, phthalates, pesticides); spironolactin Spiractin; digoxin; and . 
  •              –physical trauma eg underwire bras;                        xray (eg airports and xray screening mammography), electromagnetic fields eg electroblankets.
  •              -other toxin overload –  aspartame,  marketed designer drugs (eg  painkillers, statins, psychotropes, bloodthinners, antiinflammatories- even paracetamol Panado acetaminophen Tylenol);                         and      –overload metals  (eg iron, fluoride, bromide, chloride,  aluminium, lead, mercury, – consider detox.
  •    Do (Lymphatic) breast massage with eg anticancer coconut oil, DMSO, Lugols iodine; 
  •   Breastfeed your babies;
  • &  To avoid common deficiencies (on our depleted polluted GMO-fastfood diet, especially with increasing longevity), which contribute to all common diseases,                             take plenty of
  •      –sunlight; melatonin & enough restful natural sleep and relaxation!
  •      -organics eg green/coloured  vegetables/ juice daily. .
  •      –fish oil ie marine  omega-3  (dont fry  in  Om6 plant oil)
  •      -for lipidemia,  overweight, diabetes, the prime insulin sensitizer-weight/appetite reducer galega/metformin to tolerance;
  •      –iodine as eg kelp, or Lugol’s iodine.
  •      -vitamin D3:  with cancer, target  blood vitamin D level 70 to  100 ng/ml ie we need about  70-100iu/kg/day – and   sunshine and food cant provide this. . .
  •      –natural vitamin A – organic eggs, raw butter, raw whole milk, and beef or chicken liver, or a supplement.
  •      -buffered vitamin C about 50mg/kg/day    up  to tolerance;- with acute infection/inflammation/cancer  in an  adult, this may be 1/2 up to >2gm hourly till better, or diarrhoea, then (like metformin) just enough to avoid diarrhea;
  •      -virgin coconut oil & DMSO each 1(-15) tsp/day;
  •      -magnesium about 5 mg/kg/d; calcium phosphate;
  •      -zinc, chromium, selenium, manganese, boron;  and
  •      –vits Bco, CoQ10, &  K2.
  •      -natural estrogen-aromtase inhibitors to lower adverse estrogen dominance, raise  the  2OH:16OH estrone balance to about 2:1 – eg exercise; lecithin/choline (from eg  eggs/seeds);  oranges/lemons, red grapes, passionfruit;  celery, parsley, basil, artichokes, avocado,coconut, onions, garlic, olives, olive leaves; asparagus, squash, cauliflower, broccoli/cabbage/spinach/Brussels (provide I3C/DIM di-indole methane), yams, milk thistle,  sawpalm, diet fibre,  black radish, mushroom-astragulus, sutherlandia, beet, dandelion, curcumin turmeric, cinnamon, ginger, honey, garlic,  black pepper; taurinemethionine; zinc, selenium, vits C/D3/E/K2; and/or balancing  progesterone/ testosterone – or just 7ketoDHEA in the elderly..

Just this  month, a major trial from UCLA (Smith, Kurzer ea) confirmed that in healthy sedentary young women, moderate exercise 2.5 hour a week significantly beneficially  lowered the risky  estrone level  and raised  the             2OH:16OH estrone ratio.

These preventative steps may remove justification for therapeutic mastectomy (which is known to reduce survival)  for localized breast cancer , let alone preventative bilateral mastectomy even in women with high penetration BRCA genes, as publicized this month  by filmstar Angela Jolie .