New York to Dallas (and more on vitamin D)
Just got in from a whirlwind trip to New York, which ended up what with family and business obligations being the busiest trip there I’ve ever experienced. MD and I have just enough time to go through the mail, do laundry and head back to the airport to fly to Dallas for Christmas. Once back, we’ll have some time of our own.
I have to apologize yet again for not answering the many comments that have stacked up. I simply haven’t had time. But I will get to them, I promise.
The photo at the top of this post is St. Patrick’s Cathedral on Madison Ave. taken from our hotel room window a couple of nights ago.
Below is a photo of the two women in my life: wife and granddaughter. And below that is a photo of an exhausted grandfather and an even more exhausted granddaughter taken at about 1 AM, way past both of our bedtimes.
My harried schedule cut short my meeting with Gary Taubes so that I wasn’t able to convey to him the questions that many of you posted. I think I can talk him into either a guest post or a Q & A with answers posted. Gary and I were supposed to get together last Friday late in the morning. He had a lunch scheduled in the early afternoon, so we figured we would have plenty of time before to meet. I caught a cab to head down to our meeting place at 11th and 6th and got snarled up in all the holiday traffic and was abysmally late. By the time I got there, we were able to chew the fat for only 45 minutes or so. I tagged along with him to his lunch meeting, which was with Nina Teicholz, the journalist who wrote the great article on saturated fat for Men’s Health. (Gary and Nina are probably the only journalists who are low-carb friendly in New York.) I could only hang out for a few minutes with them before I had to scuttle back to midtown for yet another appointment. I got smart on the way back and took the subway to avoid the horrendous traffic.
I’ve got a bunch of posts in the works: new low-carb papers, vegetarian diets and free radicals, more Anthony Colpo silliness, the Anthony Colpo disciplinary post, and vitamin D.
While awaiting my scheduling problems to abate so that I can get back at it full force, here is a great article on the importance of vitamin D from the CBN, of all places. Be sure to watch the video. I tried to embed it and ended up crashing my machine. I think I’m the only person who can crash a Mac. If someone out there knows how to embed this video, let me know, and I’ll give it a try.
If you live anywhere in the northern US (and that’s above El Paso, Texas), in Canada or in Europe, you need vitamin D3 in pretty large doses. I take at least 5,000 IU daily during the winter and sometimes a 50,000 IU booster capsule if I’ve been exposed to a lot of sick people (for instance the lady who sat across the aisle from me on the flight last night and coughed the entire way). If you are like most of the New Yorkers I met and are fish-belly white, you need vitamin D. If you are African American you need vitamin D. Don’t leave home without it.
I’ll post again from Dallas. And, if I have my normal airline experience, I should have a lot of time cooling my heals at various airports tomorrow. If I do, I’ll catch up on all the comments that have stacked up. Pray for me.
Ah I wish I had checked back on the comments. I leave Christmas day in the early a.m.
I hope you have a Merry Christmas.
Warm Cheers,
Alex
Ah, too bad. We could have gotten together for a glass of Christmas cheer. I’m pretty much tied up with family obligations for the rest of today (Christmas Eve). Maybe next time. I come to Dallas often.
Merry Christmas to you.
Cheers–
MRE
I’ve done the research, and came to a somewhat different conclusion that you may want to consider. There is a plateau between about 100 nm/L and 200 nm/L (divide by 2.5 to get ng/ml) where changes in vitamin D3 intake have less of an effect on 25-D levels than outside that range. This plateau is likely the true “normal” for humans getting adequate sunlight, and it may be questionable as to whether it matters much where one is in this range. To get to the bottom of this range typically requires at least 1000 IU, and usually more. To get to the top of the range may require over 10,000 IU. So your “5000 IU” sits somewhere in the middle, and is probably safe and adequate. However, it’s not true that everyone needs 5000 IU to get into this normal range, and the smartest approach is probably to start with 2000 IU and to get your 25-D level checked to see if you need more. Another consideration is that D works in concert with other vitamins and minerals, and it’s likely that taking too much of any one of these will result in a less than optimal combination. In other words, if you get your followers to start taking 5000 IU D3, be prepared for the possibility that you’ll be making them deficient with respect to some other vitamin or mineral. In particular, a vitamin that I don’t think you’ve spent much time talking about is vitamin K2, which is about as important as vitamin D (see http://www.vitamink2.org). Anyway, I hope your presentation addresses these issues. I generally have very high regard for whatever conclusions you come to.
Hi Warner–
I agree about the importance of vitamin K2 and will address it when I put up my definitive post on vitamin D.
And you’re right that the best way to determine vitamin D levels is to check 25 (OH)D levels and adjust from there. But the truth of the matter is that most people will never get this test done (I know the importance and I haven’t had it done myself), and since it’s difficult to get vitamin D toxic at the 5,000 IU dose, that’s a good place to start for most adults in the winter months who live in northern latitudes.
Cheers–
MRE
Adequate Vitamin A is very important for the effectiveness of Vitamin D and also protects against overdose. Here is a very nice explanation of the safety of Vitamin D and the interaction of various other vitamins with Vitamin D:
http://www.westonaprice.org/basicnutrition/vitamin-d-safety.html
The section on Vitamin A is here:
http://www.westonaprice.org/basicnutrition/vitamin-d-safety.html#ad
People are afraid of Vitamin A but it is safe in natural form (from liver, specifically fish liver oil for supplements) and in conjunction with Vitamin D (and K). Just avoid synthetic Vitamin A or Beta Carotene supplements. Also, avoid eating seal and polar bear liver, as that’s a bit too much Vitamin A.
Thanks for the links.
MRE
Dr. Mike, mind if I hijack your blog for a moment to ask Annie a question regarding those tanning beds?
Annie, could you give me a 2- to 3-sentence primer about what to look for in tanning beds? You mention low-, medium-, and high-emission beds, and balanced UVA/UVB. Are the low or medium beds better? You also mention about the UVB emissions being within Holick’s guidelines. So:
1. Which is best: low-, medium-, or high-emission beds?
2. Balanced UVA/UVB or just one or the other?
3. What is the range of emissions I should look for?
The salon owner (the “dim bulb”) said she couldn’t answer my questions, but she did say that when she and her husband were deciding which brands and which bulbs to buy, she insisted on “the type that doesn’t cause skin cancer.”
She has a bed that you can stay in a maximum of 15 minutes, and booths you can stay in a maximum of 10 minutes. I’m sure that doesn’t help you answer my questions, but I thought I’d mention it anyway since you said something about how you couldn’t stay in the “old style” booth for 15 minutes.
It’s all very confusing. Thanks for the help!
Sure. Maybe we can all learn something.
Annie?
50,000 IU booster capsule ?!?
Mike, have you read this?
http://trevormarshall.com/BioEssays-Feb08-Marshall-Preprint.pdf
And this?
http://bacteriality.com/2007/09/15/vitamind/#9
I will be interested to see what Dr. Eades says about this. However, the article is somewhat suspect in my opinion. I read the first Q & A and there are a couple red flags:
1. He is very adamant that the cause of a variety of health issues is a bacteria. He seems to be overselling his opinion on this subject.
2. His comment “it seems little wonder that vitamin D has become so popular. It’s basically an over-the-counter steroid.” telling us that people take vitamin D because it is a OTC steroid seems pretty far fetched. IMO, he is making it sound like people are taking vitamin D to get some kind of high, which I think is completely false.
I am sure other can offer a far more valuable evaluation of this article. I am not that impressed with it, and won’t stop taking vitimin D because of what this guy says.
When In doubt about what to do, I look to nature if at all possible. In nature, Paleo man would have had far more sun exposure than most of us do. He would have also ate much more vitamin D than we do in sources like whole sea food and in liver. Supplementing to get us closer to what Paleo man would have gotten seems quite reasonable.
“he is making it sound like people are taking vitamin D to get some kind of high”
No, he’s making the case that elevated 25-D suppresses your innate immune response, thereby reducing inflammation without addressing its underlying cause. It’s like applying a steroid cream to treat a fungus infection – you may get some symptom relief, but the fungus infection gets worse. Basically, anytime that you hear that someone “feels better” taking high doses of vitamin D, the question needs to be asked whether that’s simply because they’ve suppressed their normal (and beneficial) immune response.
I don’t know what the answer is to all of this, and I no longer have a clue as to what to do about vitamin D supplementation, but Marshall is a serious player, as shown by this link to his site and a review of the reasons why vitamin D supplementation may not be such a smart idea:
http://www.marshallprotocol.com/forum2/10821.html
This isn’t a link to his site – it’s a link to someone writing about Marshall’s theories. I’ll post on this soon.
“This isn’t a link to his site – it’s a link to someone writing about Marshall’s theories”
http://www.marshallprotocol.com is one of several sites he’s associated with, and it is not just “someone” writing about Marshall’s “theories”. He has a group of people who help those trying the Marshall Protocol (MP). I see nothing wrong with this, nor much difference with your pushing 5000 IU vitamin D on this site/blog, even though we really don’t know what the long-term consequences of that will be. I think we are all more in the dark than the light when it comes to vitamin D.
I don’t have a horse in this race, and am only interested in the science and it’s implications. However, I think we need to be careful about dismissing the MP given its apparent success, and what it may mean with respect to vitamin (hormone) D supplementation. Specifically, even if the guy is wrong, one still needs to explain at some point all the things he’s seeing – a point that is often missed when restricting our attention to well-designed studies. In other words, we often want to dismiss outright the research of others if it doesn’t quite meet our standards, but the truth is that the best theory should be able to explain not only the results of well-designed studies/experiments, but (eventually) also those of poorly designed ones, including the first-hand experiences of doctors and patients.
So what I want to see is not just a healthy skepticism, but also an explanation of what Marshall’s seeing from the viewpoint of the vitamin-D-is-great side of the fence. This seems to be particularly important in this case because there isn’t much middle ground here – we’re either talking about avoiding almost all D supplementaion, or taking huge doses.
Re: Kathy’s Indoor Tanning Questions
I too encountered “dim bulbs” who worked at or managed or even owned tanning salons yet were clueless as to the differences and benefits regarding high versus low emission beds. Some also gave factually incorrect info. Example 1: an owner said that UVA only emitting beds are less damaging to the skin because they don’t contain the UVB which causes sunburn. Example 2: a manager argued that there is absolutely no difference between UVA and UVB. Example 3: a clerk gave me a blank stare and asked me to repeat the question — I did — 3 more times and all I got for my trouble was 3 more blank stares. Many salons only carry the UVA only beds but there are still some with the other type. The truth is that the UVA only beds can cause more damage despite no burn. Sunlight provides both UVA and UVB and so should an indoor tanning both unless one just wants a tan and is not looking for vitamin D benefits. Early indoor tanning beds emitted both UVA and UVB “low-pressure lamps” but the consumer demand was for a faster TAN — nobody talked about vitamin D synthesis — so the newer machines “high pressure” lamps emitted only UVA rays. These are still the bed of choice for many who just want to look tan as fast as possible. You can stay in the beds much longer than the other types and hence get tan faster. The gal at the desk of the salon I go to called the bulb supplier in front of me to ask for the UVA/UVB emission specifications.Holick claims there is a trend back toward the balanced emission beds. According to Holick, if one is interested in vitamin D synthesis in the skin, look for “low-pressure” beds that have a balanced UVA/UVB radiation emission (94-97.5% UVA to 2.5%-6% UVB) that replicates sunshine. For detailed info on how long to stay in for vitamin D synthesis, I really suggest you buy Holick’s book because this is not a one-size-fits-all approach. Much depends on skin type, what latitude you live at, and special concerns ie whether or not one has had skin cancer or cannot tan etc. Here’s a possibility I may look into for next season — Dr. Mercola has recently begun selling home tanning lamps with balanced emissions on his websites. They are stand-up panels that really do not seem to require much room and should work nicely in my teensy nyc apartment — then I could store easily during the Spring and Summer. Remember, Holick is NOT advocating tanning — that is not the goal of this — vitamin D synthesis is. But he acknowledges that many people like the look of a tan and will want one so he goes to great length to explain the skin aging and other risks of tanning. He says tanning is a personal choice and one should be fully informed of the potential risks and purported associated risks (photoaging, squamas and basal cell carcinoma etc) and then decide if the risks are worth it. He is constantly misquoted on the tanning issue by pale-faced sun-phobe dermatologists. One NYC derm calls those who like to tan in the sunshine mentally ill! Guess I should be fitted for a straight-jacket cause nothing makes me feel more relaxed than lying on a sunny beach. I’ve taken to exercising outdoors as well and find doing so in the sunshine is a real mood elevator for me. Hope this was helpful — good luck!
Thanks, Annie. Very informative. (For those interested in Holick’s book, click here.)
Cheers–
MRE
Dear Mike,
I’ve found, with great surprise, that Florence and Pisa (Italy) have the same latitude as Toronto (Ontario – Canada). That is 43°46′ lat. N.
Now I’m a bit confused.
Obviously (I’ve visited both) these two places have very different climates because latitude isn’t the only parameter the climate depends on. At least I suppose…
But regarding to Vitamin D production in the skin, latitude should be tho only parameter to consider.
So… same latitude (and same skin) = same Vitamin D production.
Does all this mean that needing for Vitamin D supplements in Florence is the same as in Toronto?
If this is true, then would be the recommendation of the Canadian Cancer Society valid also in Central Italy?
Am I wrong?
Thanks a lot.
Marco
Hey Marco–
I’ve spent a lot of time in both Florence and Toronto, and I can tell you that Florence is a lot hotter (and sunnier, it seems) than Toronto, yet they are both at the same latitude. Since I don’t have a clue much about climatology, I can’t tell you why the weather difference given the similar latitudes. Maybe Florence gets more sun because it is less cloudy – I don’t know. Seems hard to believe that you wouldn’t make more vit D most of the year in Florence than you would in Toronto. Maybe other readers can weigh in.
To Dr. Eades,
My OBGYN has concluded because I am border line osteopenia and osteoporosis, she has strongly suggested one of the meds, i.e. Avista. The doctor’s reasoning for the meds is to prevent a broken hip and cancer. When I asked if she would write a script for a D3 level she agreed, but said she still wanted me to take the Avista regardless of the level.
My nutritionist says to “run the other way”. She was surprised the OBGYN did not order a D3 level right away. She says to have my blood levels drawn for D3 levels at intervals.
The object is to start to build bone density as the D3 will gradually allow the calcium to be absorbed. Shaklee has 1000mg. calcium, 400 mg. magnesium, 400 IU D3.
I have used sunscreen SPF15, on my face and arms for years because of the itching allergy to the sun. The sun does not affect my legs.
Could you comment? How much D3 should I be taking? What are the recommended levels for a middle aged woman?
I can’t make comments on specific medical conditions. I usually give my own patients – and I myself take – 5000 IU Vit D3 per day. Unless I spend a lot of time outdoors in the summer. Then I skip it.
25 (OH)D (the only vitamin D test that is really valid) levels should be between 50-80 ng/ml.
Dear Dr. Eades,
I feel compelled to tell you about my success with weight loss after taking a high dose of Vitamin D. I should probably explain my situation and why I’m taking such a high dose. Last spring I had a baby and breastfed exclusively. I wanted to lose the baby weight and after reading several books including PPLP and Good Calories Bad Calories I decided that a low carb approach was not only the best way to lose weight but also the most healthful. I am eating a low-ish carb diet (about 60g/day). One problem I’ve run into is that there is almost no information about eating low carb during pregnancy and lactation. I was afraid to eat low carb while pregnant because I’d read that ketones could harm the baby’s brain, so I ate carbs and gained weight. Perhaps you could shed some light on this issue for me? On to the vitamin D story.
Over the course of last summer I lost about 15 pounds, but once fall hit my weight loss completely halted. I tried your calorie reduction approach and I would lose weight only if I went to bed hungry, but I couldn’t sustain that and would gain it back. I live in an area where I get basically no sun during the winter. I became concerned about low vitamin D levels in my breast milk, and I read some studies that seemed to indicate the 2000 IU/day I was taking at the time was probably not enough to maintain an adequate level of vitamin D for my baby. After looking at several studies I decided to start taking 6400 IU/day. Some of this comes from cod liver oil and the rest from vitamin D3 pills. It took a few weeks but I suddenly started dropping weight. I’ve lost 10 pounds in the last 6 weeks. I’ve made no other changes. I wondered if you know of the possible mechanism for this or if you’ve seen this in your practice. Thanks for your time.
Karin
Thanks for the informative comment. There is a little evidence in the medical literature that vitamin D helps with the weight loss process, but nothing really conclusive. It certainly seems to have helped a lot with yours. I’m sure this comment will inspire a few others to give it a try.
My Dr. after doing blood tests found I had practically no Vitamin D. This was discovered while testing for an adrenal gland that was no longer producing. He recommended 5000 IU–which I have now been taking for a week. I take it at night with Oscal 500 with D. The first night I took it I slept all night like a baby (I have had problems not getting to sleep, but staying asleep). It has been like this every night since I started taking D3 with the calcium. I also have had diarhea with practically everything I eat for 4 years since I had my gallbladder out. Greasy food intake or spicy food is in and then immediately out. Since starting on the D3 I noticed my diarhea had stopped. The other thing I have noticed is pain I have had has almost subsided. For many years to run my hands over bones in my legs, arms, etc. has almost gone away. Without adequate adrenal gland function I felt sometimes I was hanging on by my fingernails. I am calmer and more relaxed–almost like my old self (which was very laid back). I feel much better after reading your comments on taking D3 . I always thought it was toxic or could be because it is oil soluble. Should I have my blood tested at intervals to be sure I’m not getting to much or too little? I am 66 years old and active.
Thank you,
Lee Kennedy
Dear Dr Eades,
I live in NE Oregon.
From what I have been able to deduce, if a person lives more than 45 degrees from the Equator during the winter, any tan they get from the sun, even at noon, in January, will not indicate they have gotten any Vitamin D for their efforts. Is this true?
Does the tan come from just UVA exposure in winter at my latitude? Is this kind of tan all cost and no benefit?
Thank you,
David Waln
The tan comes primarily from UVA, which doesn’t produce vitamin D. It’s tough to get enough at your latitude in the winter months. Here is a blog post you might find interesting.