Dr. Gerry Schwalfenberg of the University of Alberta just published the first case report of a woman with a treacherous autoimmune disorder, idiopathic thrombocytopenic purpura or ITP, that vitamin D apparently cured.

Schwalfenberg GK. Solar radiation and vitamin d: mitigating environmental factors in autoimmune disease. J Environ Public Health. 2012;2012:619381.

More than 160 known autoimmune disorders exist in humans and more than 5% of the population has at least one of the disorders. They occur when your immune system malfunctions and attacks your own organs or tissues. No known cure exists. In the above publication, Dr. Schwalfenberg reviewed an extensive number of newer medical papers and concluded that, “Evidence that autoimmune disease may be a vitamin D-sensitive disease comes from many sources.”

He then reports on a 48-year-old female with one of the rarest and more perilous autoimmune disorders, ITP, which destroys platelets. Platelets help with blood clotting, and doctors follow platelet counts closely in ITP. She had been ill since 1998, had her spleen taken out to help elevate her platelet count and was on the best medicine for the disease, danazol. However, she continued to suffer from dangerously low platelet counts.

Visible symptoms of ITP include bruises, bleeding from the nostrils, bleeding at the gums, and excessive menstrual bleeding. A very low platelet count may result in blood masses in the mouth or on other mucous membranes. Bleeding time from minor cuts is usually long. Possibly fatal complications include bleeding inside the skull or brain or internal bleeding.

Knowing all the evidence that vitamin D is involved in autoimmune disorders, Dr. Schwalfenberg tested her vitamin D level in 2006 and found it to be 26 ng/ml. He started his patient on 2,000 IU of vitamin D per day. Her platelet count increased but not to normal. For the next two years, she had no symptoms of her ITP except for a moderately low platelet count. Unfortunately, a neighbor told her that 2,000 IU/day would make her toxic, so she stopped the vitamin D and her platelet count promptly fell dangerously low.

Dr. Schwalfenberg reassured her that her neighbor was incorrect and restarted her vitamin D, this time at 4,000 IU/day. She did well, and for the first time in a decade, was able to stop her danazol. She was given 10,000 IU/day of vitamin D for several days for an upper respiratory infection and her platelet count became normal for the first time in 14 years. It remains normal to this day and she is doing fine with a vitamin D level of 40 ng/ml taking 4,000 IU/day.

Prostate cancer tends to develop in men over the age of fifty and, although it is one of the most prevalent types of cancer in men, many men never have symptoms and die of other causes. On the other hand, more aggressive prostate cancers account for more cancer-related deaths than any cancer except lung cancer. About two-thirds of cases are slow growing, the other third are more aggressive and fast growing.

The decision to treat a tumor contained within the prostate is a trade-off between the risk and expected benefits, especially quality of life. More and more often physicians and patients are electing to do nothing but wait (and hopefully enjoy life) for slow growing tumors.

The decision to wait is a calculated risk. Urologists look at a number of factors in prostate cancer to decide how to treat (if at all) prostate cancer. These factors include:

• Gleason Score: score given to prostate cancer based upon its microscopic appearance. Cancers with a higher Gleason score are more aggressive and have a worse prognosis. The Gleason scores range from 2 to 10, with 10 having the worst prognosis.
• Core biopsies positive:  usually urologists take 6-12 total biopsies at a time, called cores. The percentage of positive cores varies and often changes over time.
• PSA: a tumor marker that, taken with the other two factors above, may indicate prostate cancer. The higher the score, and the more rapidly it climbs, the worse the prognosis. It usually slowly increases over time in men with low-grade prostate cancer.

All of these factors, along with the presence or absence of cancer spread, change over time and influence whether or not an urologist and patient decide to treat the prostate cancer.

To give you an idea about how this works, if you took 20 men with low risk prostate cancer and do nothing but biopsy them again in a year, about 10% of the men will no longer have any cores positive. That’s right, about 10% of men will no longer have demonstrable cancer. However, most men will have either more cores positive or a higher Gleason score or higher PSA or all three.

This week, Drs. David Marshall, Sebastiano Gattoni-Celli and their colleagues from the Medical University at South Carolina published a study that reported administering vitamin D for a year, measuring cancer markers before and after. The results were astounding.

Marshall DT, et al. Vitamin D3 supplementation at 4,000 IU/day for one year results in a decrease of positive cores at repeat biopsy in subjects with low-risk prostate cancer under active surveillance. Journal of Clinical Endocrinology and Metabolism. 2012.

This study administered 4,000 IU/day of vitamin D for one year to 44 men. The scientists chose 44 men with low risk prostate cancer, so they chose 44 men with  identical Gleason scores of 6, anywhere from 1-6 cores positive (out of 12 possible), and a PSA < 10.

Of the 44 men they followed, 60% showed a decrease in the number of positive cores or a decrease in their Gleason scores, or both. Only 34% showed an increase in the number of positive cores or an increase in their Gleason scores. 6% were unchanged over the year. PSA levels did not go up over the year. The authors classified 60% of the men as “responders” to vitamin D and 40% as “non-responders.”

Fifteen of the 44 men (34%) no longer had any cores positive. However, PSA did not go down so they may or may not still have prostate cancer. It also appeared that baseline vitamin D levels were important because men with higher baseline vitamin D levels had fewer cores positive for cancer and lower Gleason scores.

The authors report that the main problem with the study was the lack of a control group, other than historical groups of men treated conservatively. However, with 60% of the men responding to vitamin D, I wonder if an ethics committee would allow a randomized controlled trial, knowing some men in the control group would be vitamin D deficient.

He recruited 30 patients with vitamin D levels less than 20 ng/ml and put half on 5,000 IU/day and half on 2,000 IU/day for three months. He measured a number of things, the most important of which was muscle strength.

Diamond T, Wong YK, Golombick T. Effect of oral cholecalciferol 2,000 versus 5,000 IU on serum vitamin D, PTH, bone and muscle strength in patients with vitamin D deficiency. Osteoporos Int. 2012 Mar 16.

After 3 months of 2,000 IU/day the vitamin D levels averaged 30 ng/ml (75 nmol/L), meaning about half the patients were still vitamin D deficient. Not so with the 5,000 IU/day group. The average vitamin D level was 45 ng/ml (114 nmol/L), right in the “natural range.” In addition, 93% of the patients had levels higher than 30 ng/ml compared to the 2,000 IU/day group, where only 45 % had levels above 30 ng/ml. Remember, one of the problems with daily dosing is that you must rely on the patient to take their medication. As an old GP, I am here to tell you not all patients take their meds; the ones that get me are the ones who look me straight in the eye and tell me something I know is not true.

In Dr. Diamond’s well-designed study, changes in grip strength compared to baseline were very significant, while the improvements in timed tests of sitting to standing and the 6-meter walk test also improved, but not significantly. What surprised me was that the improvements did not vary with dosage. That is, the 2,000 IU/day had the same improvements in grip strength as did the 5,000 IU/day, meaning muscle strength improvements are the most dramatic at changes in lower ranges of vitamin D levels. By that, I mean if your level is 5 ng/ml to start out and you get to up to 20 ng/ml, your percentage improvement in muscle strength will be much more dramatic than someone who went from 20 to 35 ng/ml.

I am glad to see Australians using daily dosing of vitamin D. Many of the “Stoss” doses, 100,000 IU/month or 600,000/year are not physiological, and are dangerous. Vitamin D was made every day in the skin of our ancestors and we should strive to replicate such dosing schedules. How much do we need? To quote Dr. Diamond, “This study demonstrates that the administration of oral vitamin D at 5,000 IU daily is superior to 2,000 IU daily for 3 months to treat mild to moderate vitamin D deficiency.”

Source: Vitamin D Council Newsletter by Dr John Cannell

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.