January 30, 2012 — Dr John Cannell

Every year, billions are spent in fertility clinics; the result of which is often in vitro fertilization (IVF). About 5 years ago, I began receiving emails from a nurse practitioner in Indiana who works in a fertility clinic. Her experience was dramatic; 5,000 IU/day for both the man and woman frequently resulted in a healthy baby. However, her last email to me was quite sad, she was in danger of losing her job as her boss, a gynecologist, was losing money due to vitamin D. He ordered her to stop advocating it or lose her job.

Today, the Daily Mail and several other newspapers reviewed a lengthy article in The European Journal of Endocrinology that concluded, “Given the high prevalence of infertility as well as vitamin D insufficiency in otherwise healthy young women and men and the possible role of vitamin D in human reproduction, research might lead to new therapeutic approaches such as vitamin D supplementation in the treatment of female and male reproductive disorders.”

Critical to this carefully caged advice is the fact that men need help as frequently as the women do.  “Population-based studies found that in 30-40% of infertile couples the underlying cause is the male factor. In this context it should be mentioned that the overall semen quality of men is decreasing, which might partly be explained by environmental factors. Indeed, as much as 20% of young men have sperm concentration below the WHO recommendation level and 40% present with sperm concentrations below a level that is considered optimal for fertility.” Pretty amazing, especially when you realize these men have normal testosterone levels but that vitamin D levels are steadily decreasing.

Elisabeth Lerchbaum and Barbara Obermayer-Pietsch Vitamin D and fertility-a systematic review. European Journal of Endocrinology January 30, 2012

The authors go onto say, “In northern countries, where a strong seasonal contrast in luminosity (sunshine intensity) exists, the conception rate is decreased during the dark winter months, whereas a peak in conception rate during summer leading to a maximum in birth rate in spring has been observed. Moreover, ovulation rates and endometrial receptivity seem to be reduced during long dark winters in northern countries.”

While no direct studies exist of vitamin D levels and fertility per se, the authors report, “In a study among 84 infertile women undergoing in vitro fertilization, women with higher levels of 25(OH)D in serum and follicular fluid were significantly more likely to achieve clinical pregnancy following in vitro fertilization . . .”

If you don’t want to work your way through the entire 42 page paper, read the excellent synopsis in the Daily Mail below.

Carey T.  Sunny break may be alternative to in vitro fertilization: How the sunshine vitamin can help boost fertility. Daily Mail Online, January 30, 2012.

The takeaway message is the same as always, a message so common I should just start saying “ditto.” If you want to get pregnant, make sure you and your partner take 5,000 IU/day. If you don’t want to get pregnant, make sure you and your partner are on 5,000 IU/day plus a reliable method of birth control. I take no responsibility for surprise pregnancies.

Dear Dr. Cannell

On Autism

Dear Dr. Cannell:
My son James weighs 48lb, he is 7 yrs old. He had autistic symptoms for almost 5 years (first noticed when he was 2 yrs old). I initially started him on 2,000 IU last November after he caught the flu. Two weeks later, I noticed improvements in areas of social interaction, verbalization. I then increased his dosage to 5,000 IU per your recommendation, and he got better.

His progress has been so great that his kindergarten teacher and Speech Therapist have recommended that he exit the Early Intervention Program.

He is more social, making friends easily, participating in cooperative play, and soon to be in a regular classroom. I think it might be bad luck to say he is cured. Is that possible in a genetic disease? A friend told me he must never have had autism but whatever it was, I don’t want it back. I remember what he was like, and me, too. No thanks.

I’m writing because my son’s pediatrician just called and told me James’s 25(OH) level was 122. He believes he must be toxic because of that level and wants me to stop giving him all vitamin D supplements and recheck his vitamin D level next month. James feels great and shows no signs of toxicity.

What should I do?
Mary, New York

Dear Mary:
That is wonderful news about your son. He is not toxic. However, he should reduce his vitamin D to 2,000 IU/day and recheck his blood level in a month. Some of his symptoms may come back; I don’t know but do not fear, if the symptoms return the vitamin D will take care of them. It appears to me that high dose vitamin D controls, rather than “cures,” some cases of autism. If his level in a month is below 100 ng/ml, the pediatrician will be happy as that is the upper range of normal vitamin D levels.

Yes, autism is a genetic disease, so how can vitamin D treat it? I suspect that one of vitamin D’s many duties in the body is to protect your genome from mutations, organizing the correction of random and point mutations when they occur. Think of your son as having DNA that is unlikely to function properly with lower levels of vitamin D. How long his DNA will be sensitive to low vitamin D, I don’t know.

An immediate question is how much vitamin D to give him now. You want to give him the lowest dose that controls his symptoms. I suspect that he will end up needing 3,000 to 4,000 IU per day to maintain his 25(OH)D around 80-90 ng/ml.

Dear Dr. Cannell:
I just read that someone discovered “geeks” are more likely to have children with autism. I know lots of geeks ‘cause I’m one myself, and it’s scary. I seldom see the sun. Your vitamin D theory of autism fits this geek discovery to a tee. Why can’t other scientists see it?

Andy, Boston

Dear Andy:
One reason is that I’m not a real scientist, I don’t practice science. I read, think, and write. I just came back from speaking for four hours at the American Association for the Advancement of Science (AAAS), and I understand some “real” scientists are upset the AAAS invited me. If I was a real scientist (practiced science, i.e. conducted studies, worked in a lab, etc.) I’d be upset as well. It is just that I saw what scientists did not, in part because my ignorance also meant I had no preconceived notions.

I am afraid that Occam’s Razor is at work here, or “plurality should not be posited without necessity,” which is to say, keep it simple. The autism experts are jumping on and sliding down the razor, theorizing multiple new theories that certain types of minds (math and computer brains) somehow are at more risk for autism. All the autism scientists have to do is stop, open their eyes, and look where the geeks are all day long (inside, out of the sun). It’s that simple. Instead of riding the razor, they need to use Occam’s razor to cut through to the simplest theory. The story below makes it clear that the simplest possibility never crosses their minds.

Andy Coghlan NewScientist 6/20/11 Childhood autism spikes in geek heartlands

Physical Trauma and the Metabolic Clearance of Vitamin D

Dear Dr. Cannell:
Ten days ago, my wife hit a semi-truck trailer t-bone. I know her vitamin D level was 70 ng/ml a week before the accident.  Four days after the accident it was 32.  Are there any studies on major trauma and severe sudden D loss, responses to fight-or-flight mechanisms?

Thanks,
Paul, Minnesota

Dear Paul:
I hope your wife is going to be okay.  While no studies have examined the effect of massive trauma on the metabolic clearance of vitamin D, a recent study showed that having a knee replacement used up tremendous amounts of vitamin D.  It is likely that the trauma of the surgery, and the acute inflammation the surgery caused, was the reason why so much vitamin D was used up.  Be sure your wife gets 50,000 IU of vitamin D every day until she is out of the hospital.

Reid D, et al.  The relation between acute changes in the systemic inflammatory response and plasma 25-hydroxyvitamin D concentrations after elective knee arthroplasty. Am J Clin Nutr. 2011 May;93(5):1006-11.

Vitamin D Blood Serum Levels and Cancer

Dear Dr. Cannell:
I am worried about the studies that show increased risk of cancer with both high and low levels of vitamin D.  What should I do?

Sarah, Maryland

Dear Sarah:
Join the club, especially since a group of good scientists (FNB vitamin D Board) has recently said that vitamin D levels of 50 ng/ml (levels I recommend) may be dangerous. They based their warning on about a dozen studies that show a U-shaped curve, that is, increased risk with both lower and higher vitamin D blood levels. The studies that show this risk are almost all the same type of studies. Scientists take frozen blood samples drawn decades ago and test them for vitamin D in a group of subjects who doctors have followed closely, comparing them to a similar group who did not develop the disease.

However, in a very recent study, a meta-analysis of all such studies done on colon cancer, scientists showed what most studies suggest: there’s a decreased risk with higher vitamin D levels, as the authors put it, “in a linear dose-response manner.” That’s important because it suggests levels of 40 ng/ml are better than levels of 30. However, not enough people have levels high enough to answer the next logical question, “Are levels of 50 better than levels of 40?”

Touvier M et al.  Meta-analyses of vitamin d intake, 25-hydroxyvitamin d status, vitamin d receptor polymorphisms, and colorectal cancer risk. Cancer Epidemiol Biomarkers Prev. 2011 May;20(5):1003-16.

The studies that show a U-shaped risk (increased risk with low and high vitamin D levels) share several similarities. Many, but not all, were conducted in Scandinavian countries, where cod liver oil consumption is high and vitamin A toxicity will run hand in hand with high vitamin D levels. Virtually all were conducted at fairly high latitudes, where a steep fall-off of vitamin D levels occurs in the autumn, a decline that may – according to Professor Reinhold Vieth – cause repeated yearly episodes of intracellular deficiencies of vitamin D. Finally, virtually all the studies share the similarity that scientists measured the vitamin D levels in blood taken during the 1980s and ’90s that had been frozen for at least a decade.

Most, but not all, of the studies in question are cancer studies, especially prostate and pancreatic cancer. If higher vitamin D levels are riskier, then perhaps those who develop cancer will die sooner if their vitamin D levels are high? The exact opposite is true. Studies show that the higher your vitamin D levels at the time of a cancer diagnosis, the longer you live. That is, higher vitamin D levels have a treatment effect in cancer.

Such studies exist for breast, colon, melanoma, lung, and prostate cancers. The higher the vitamin D level at the time of a cancer diagnosis, the longer you live. Similar findings were recently announced for a leukemia that is currently “incurable,” chronic lymphocytic leukemia (CLL). To quote the authors, “”the association between 25(OH)D and survival increased consistently as 25(OH)D increased.” The authors added, “these findings suggest that vitamin D insufficiency may be the first potentially modifiable host factor associated with prognosis in newly diagnosed CLL.” In other words, vitamin D may be the first effective treatment for CLL. Way to go vitamin D!

Shanafelt TD et al. Vitamin D insufficiency and prognosis in chronic lymphocytic leukemia. Blood. 2011 Feb 3;117(5):1492-8.

Please note one other thing. These studies clearly show that people with high vitamin D levels still can get cancer. That is, vitamin D only reduces the risk of getting and dying from cancer; it does not prevent it. This is important because we all know, or will know, someone who took vitamin D and died from cancer anyway. Humans being who they are, friends and relatives of such cancer victims will become dispirited; silently hoping vitamin D is a sure cure. Vitamin D is not that. As I say when I speak, everyone who takes vitamin D will die.

Vitamin D in ICUs

Dear Dr. Cannell:
Why don’t they give vitamin D in the ICU in the hospital? I think they know it will hurt their business.

Jeff, California

Dear Jeff:
When I was young, I always suspected conspiracy. As I grow older, I see that it is usually incompetence. Things are beginning to change. For example, several months ago the journal Critical Care had just the kind of study you are implying the system will not do. They gave 540,000 IU to ten patients near death in an ICU. They gave it via a feeding tube and then compared those patients to ten patients given a placebo. They found that 540,000 IU as a single dose will achieve levels of around 40 ng/ml, but it takes three days to do so (the patients started with levels of around 12 ng/ml).

Amrein K, et al. Short-term effects of high-dose oral vitamin D3 in critically ill vitamin D deficient patients: a randomized, double-blind, placebo-controlled pilot study. Crit Care. 2011 Mar 28;15(2):R104

The overall death rate between the two groups was the same, 50%, but vitamin D patients who still had low blood calcium (common in an ICU) at day three were three times more likely to die than those who obtained normal blood calcium, but the numbers were not large enough for significance. However, the findings suggest that doctors need to give it earlier and give it either intramuscularly or intravenously. Larger doses probably won’t help as the body can’t deal with that much. I predict that eventually vitamin D will be available as an IV and that the most useful preparation will be intravenous 25(OH)D. Oral 25(OH)D was taken off the market several years ago, before the vitamin D revolution began.

The Latest on Vitamin D and Hepatitis C

Dear Dr. Cannell:
I have hepatitis C. Any new studies about vitamin D and hepatitis?

Andy, Florida

Dear Andy:
Last year, scientists announced an exciting development at a liver disease conference: vitamin D helped some people get rid of the infection.

Dan Evan. Haaretz.com Study: Vitamin D could help fight hepatitis C. Already heralded in battling cancer, Vitamin D may also be key to curing hepatitis.

This year a small study showed vitamin D improved the chance that standard treatment, interferon, helped reduce viral loads.

Bitetto D et al. Vitamin D supplementation improves response to antiviral treatment for recurrent hepatitis C. Transpl Int. 2011 Jan;24(1):43-50

My advice: if you have hepatitis, keep your vitamin D levels in the high normal range, 70-90 ng/ml.

Does vitamin D reverse gray hair?

Dear Dr. Cannell:
I want to thank you for your efforts to promote the benefits of vitamin D supplementation. It’s amazing, that the risk factor “vitamin D-deficiency” could so easily, safely and cheaply be treated! But there’s still a lot to do until this fact will be really accepted and realized by the public.

For a few months I have been reading every paper I find about vitamin D and supplementing vitamin D. Since then I hardly had any respiratory infections anymore and much less muscle aches after doing sports!

I also advised my mother to supplement vitamin D and she told me that since then she has less gray hair and the hair is getting colored again!

When I Googled this topic I found many comments and threads of people who had the same experience.

What do you think about it? I’m sure vitamin D helps against gray hair!

It’s really interesting!
Heinrich, Germany

Dear Heinrich:
It would not surprise me as the hair follicle has a vitamin D receptor. However, If it gets rid of gray hair in some people, I’m not one of those people.

John Cannell, MD
Executive Director
Vitamin D Council
1241 Johnson Ave., # 134
San Luis Obispo, CA 93401

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Their research group reported that 2,000 IU/day of vitamin D, given for 12 weeks, significantly improved pancreatic function in mildly overweight adults with pre-diabetes. Unfortunately, the lead author, Dr. Joanna Mitri, did not comment on the low dose of vitamin D they used, 2,000 IU/day, which only increased vitamin D levels from 24 to 30 ng/ml. Nor, in spite of it being a randomized controlled trial, did the authors make any new clinical recommendations for the people who paid for their study, the citizens of the United States.

In spite of the low dose and short length of their study, they found their principal outcome, a measurement of pancreatic function, increased by 300 in the vitamin D group but fell by 126 in the placebo group. I cannot link the study to PubMed as it is not yet listed there; it will be in a few days.

Joanna Mitri, Bess Dawson-Hughes, Frank B Hu, and Anastassios G Pittas.  Effects of vitamin D and calcium supplementation on pancreatic b cell function, insulin sensitivity, and glycemia in adults at high risk of diabetes: the Calcium and Vitamin D for Diabetes Mellitus (CaDDM) randomized controlled trial. AJCN. First published ahead of print June 29, 2011 as doi: 10.3945/ajcn.111.011684.

In the end, they studied 22 volunteers in the vitamin D group and 22 in the placebo group. However, to give you an idea of what a feat this study was, how difficult it was to get enough subjects, they started with 911 subjects yet ended up randomizing only 44 into the vitamin D study. They did a parallel calcium study with 45 subjects, which found calcium had no benefit on pancreatic function.

The same senior author, Professor Anastassios Pittas, recently announced the results of a much larger epidemiological study that showed for every 5 ng/mL increase in vitamin D levels, the risk of developing diabetes dropped by 8%.  However, he was quick to warn that such epidemiological studies should not change clinical recommendations, only randomized controlled trials can do that. Then, when he oversees just such a randomized trial, not a word of clinical advice, only the ever-present request for more research money from the citizens of this country.

http://diabetes.webmd.com/news/20110628/study-vitamin-d-may-cut-risk-of-diabetes

Of course the Food and Nutrition Board will say they never said levels greater than 20 ng/ml had no added benefits, only that no good evidence existed for such a benefit at the time they issued their report. Actually, if you exclude the science of epidemiology, that is still a false statement. The point is that history will record that someone was wrong.  Maybe it will be me and the Vitamin D Council’s recommendation, going into its fifth year, that adults should take at least 5,000 IU per day.  Or maybe it will be Professor A. Catharine Ross, of Penn­sylvania State University, the chairwoman of the recent FNB that concluded 600 IU/day is the Recommended Daily Allowance, all adults need.  Looking at the study published today, it is clear that 600 IU/day would not have resulted in a significant improvement in pancreatic function.

I predict that after most of the randomized controlled trials are out – in another ten years – the FNB will meet again and say “whoops,” it should have been 5,000 IU/day all along. However, by then the premature death count will be in the millions.

John Cannell, MD
Vitamin D Council

Infections in immunosuppressed patients can result in life-threatening secondary infections from bacteria and fungi, especially since bacteria, like Staphylococcus aureus for example, are becoming multi-drug resistant (the so termed MRSA infections). Thus, researchers from Rohtak, India, tested extracts from several plants used in traditional or folk medicine against microbials found in the mouths of oral cancer patients.

Of the 40 patients involved in the study, 35 had compromised immune systems with severely reduced white cell counts. Eight of the plants tested were able to significantly affect the growth of organisms collected by oral swab, and pure cultures of bacteria and fungi grown in the lab. This included wild asparagus, desert date, false daisy, curry tree, caster oil plant and fenugreek.

Dr Jaya Parkash Yadav said, “Natural medicines are increasingly important in treating disease and traditional knowledge provides a starting point in the search for plant-based medicines. Importantly we found that the extraction process had a huge effect on both the specificity and efficacy of the plant extracts against microbes. Nevertheless several of the plants tested were broad spectrum antibiotics able to combat bacteria including E. coli, S. aureus and the fungi Candida and Aspergillus. Both desert date and caster oil plant were especially able to target bacteria, such as Pseudomonas aeruginosa, which are known to be difficult to treat with conventional antibiotics.”

Dr Yadav also stated that, “Although the plants tested had a lower potency than conventional antibiotics they offer hope against resistant species. These results are a starting point for further testing in the lab and clinic.”

The research will be published as follows:

Manju Panghal, Vivek Kaushal and Jaya Parkash Yadav, In vitro antimicrobial activity of ten medicinal plants against clinical isolates of oral cancer cases, Annals of Clinical Microbiology and Antimicrobials (in press).

Readers may also be interested in an earlier article: Natural Antibiotics