From the Vitamin D Newsletter by Dr John Cannell.
Psychosis, or loss of touch with reality, is difficult to see in any loved one but is particularly difficult to deal with if it’s your teenager. Dr. Barbara Gracious and colleagues recently discovered that of 104 teenagers assessed at an acute mental health clinic, the teenagers with the lowest vitamin D levels were more likely to be psychotic. In what must be a tribute to video games and the like, 72% of the teenagers had vitamin D levels lower than 30 ng/ml and 34% had levels lower than 20 ng/ml.
The magnitude of the vitamin D effect was not minor; if the teenager had low vitamin D levels, he or she was almost four times (OR=3.5) as likely to be psychotic.
Gracious BL, Finucane TL, Freidman-Campbell M, Messing S, Parkhurst MM. Vitamin D deficiency and psychotic features in mentally ill adolescents: A cross-sectional study. BMC Psychiatry. 2012 May 9;12(1):38. [Epub ahead of print]
I was disappointed with their usual call for more studies instead of the needed call to treat vitamin D deficiency now. Compare Dr. Gracious’s approach to that of Dr. Mats Humble’s approach at Sweden’s Karolinska Institute. Dr. Humble and colleagues assessed 117 mental health outpatients of all ages and found that teenagers had the lowest levels. Teenage females had vitamin D levels of around 20 ng/ml and, in another nod to video games, teenage Swedish males attending a mental health clinic had average vitamin D level of around 10 ng/ml.
Humble MB, Gustafsson S, Bejerot S. Low serum levels of 25-hydroxyvitamin D (25-OHD) among psychiatric out-patients in Sweden: relations with season, age, ethnic origin and psychiatric diagnosis. J Steroid Biochem Mol Biol. 2010 Jul;121(1-2):467-70. Epub 2010 Mar 7.
Dr. Humble also found that depressed, psychotic and autistic patients had the lowest vitamin D levels and anxiety patients had the highest levels. Instead of just calling for more trials, he treated the deficient patients with up to 4,000 IU/day of cholecalciferol or, in other cases, up to 70,000 IU weekly of ergocalciferol, which resulted in “considerable improvement” in psychosis and depression.
No doubt, Dr. Humble is busy conducting a randomized controlled trial. At least I hope so. Moreover, I hope he is using pharmacological doses of vitamin D, not physiological doses. That is, I hope he is using 10,000 IU/day and not 5,000 IU/day, although some may claim 10,000 IU/day is physiological.
I predict the day will come when using 50,000 IU/day for ten days in very ill people with a vitamin D responsive disease, such as sepsis, congestive heart failure, and perhaps psychosis, to name but a few, will be commonplace. Now, 50,000/day is a pharmacological dose, which simply means the vitamin D is being used as a drug and not as a supplement for good health.
Tags: low vitamin D and psychosis, Psychosis in teens, vitamin D
Tobacco use is the leading preventable cause of death worldwide. Approximately 6 million deaths related to tobacco use occur each year, including 600,000 from second-hand smoke. If current trends continue, according to the World Health Organization (WHO), by 2030, approximately 8 million persons will die each year from tobacco use, and 80% of those persons will reside in low- and middle-income countries (1).
In 1987, WHO designated May 31 as World No Tobacco Day to draw global attention to the health risks of tobacco use. In 2005, provisions of the WHO Framework Convention on Tobacco Control took effect. A total of 175 countries have ratified this treaty, making it one of the most widely embraced treaties in United Nations history (2).
The treaty commits countries to protect the public’s health by adopting various measures to reduce demand for tobacco. Those measures include increased pricing of tobacco products, protection from exposure to tobacco smoke, and regulation of product contents, packaging, and advertising (3). A reduction in smoking prevalence worldwide of 20%–25% could prevent 100 million premature deaths by 2020 (4).
References
- World Health Organization. World No Tobacco Day 2012. Geneva, Switzerland: World Health Organization; 2012. Available athttp://www.who.int/tobacco/wntd/2012/announcement/en/index.html
. Accessed May 17, 2012. - World Health Organization. About the WHO Framework Convention on Tobacco Control. Geneva, Switzerland: World Health Organization; 2012. Available at http://www.who.int/fctc/about/en/index.html. Accessed May 7, 2012.
- World Health Organization. WHO Framework Convention on Tobacco Control. Geneva, Switzerland: World Health Organization; 2005. Available athttp://whqlibdoc.who.int/publications/2003/9241591013.pdf
. Accessed May 18, 2012. - Frieden T, Bloomberg M. How to prevent 100 million deaths from tobacco. Lancet 2007;369:1758–61.
Source
Morbidity and Mortality Weekly Report (MMWR) May 25, 2012 / 61(20);365
Tags: Quit Now, World No Tobacco Day
Metabolic clearance of vitamin D after heart attack
This week, Dr. Julian Barth, and colleagues, of the University of Leeds, discovered that vitamin D levels do not decline after a heart attack. At least they do not decline beginning 2 days after the heart attack. This implies vitamin D is not being “used up” or metabolically cleared during the healing of the heart attack.
Dr. Barth studied 48 patients with an acute myocardial infarction (MI) and measured 25(OH)D levels after 2 days, 7 days, 30 days and 90 days post-MI. Inflammation was occurring during this time, as evidenced by rise and fall of CRP, but they found no relationship between CRP and 25(OH)D.
They did not measure vitamin D levels before the heart attack (understandably), so we don’t know if 25(OH)D levels declined from before to after the heart attack (that is, during the acute event). We do know they don’t decline when a damaged heart is healing. Dr. Barth cited a study that found the same thing with an acute malarial infection: vitamin D levels don’t decline during the acute phase of a malaria infection.
(The good news is that people in Leeds are going outside more than during the sun scare. In the winter average 25(OH)D levels were 9.6 ng/ml; in the spring, 15.8; in the summer 30; and in the fall 18 ng/ml, although the numbers were small.)
Compare the lack of metabolic clearance of vitamin D after a heart or malaria attack to what occurs after a knee replacement. Dr. Reid and colleagues of the University of Glasgow found 25(OH)D fell dramatically after a knee replacement. I have reported on this before.
They measured 25(OH)D before and after a knee replacement on 33 subjects and found 25(OH)D reduced by 40% from before to 2 days after the surgery. Even at three months, 25(OH)D was still 20% lower than preoperative levels indicating, perhaps, the healing knee was “using up” or metabolically clearing the vitamin D. Again, since we don’t know what the 25(OH)D levels were before the MIs in Dr. Barth’s paper, we don’t know if acute MI’s metabolically clear any vitamin D. I suspect they do, although nothing like a knee replacement, which involves major damage to a large joint.
While we only definitively know about the effects of knee replacement surgery on 25(OH)D, I think in the meantime it’s important to be sufficient in vitamin D for lots of reasons when going to the hospital. The take home message is that if you are going into the hospital for any reason, especially surgery, make sure you have plenty of vitamin D reserves by having your 25(OH)D at around 50 ng/ml before admission.
The above article was authored by Dr John Cannell of The Vitamin D Council.
Tags: vitamin D, Vitamin D in Medical and Surgical Conditions
The MedWatch April 2012 Safety Labeling Changes posting includes 43 products with safety labeling changes to the following sections: BOXED WARNINGS, CONTRAINDICATIONS, WARNINGS, PRECAUTIONS, ADVERSE REACTIONS and PATIENT PACKAGE INSERT.
The “Summary Page” accessible via the link below provides a listing of drug names and safety labeling sections revised:
http://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm302285.htm
The following drugs had modifications to the BOXED WARNINGS, CONTRAINDICATIONS and WARNINGS sections:
- Aceon (Perindopril Erbumine)
- Altace (Ramipril)
- Atacand (Candesartan Cilexetil)
- Sporanox (Itraconazole)
- Zortress (Everolimus)
- Advicor (Niacin Extended-release/Lovastatin)
- Altoprev (Lovastatin Extended-release)
- Amturnide (Aliskiren, Amlodipine and Hydrochlorothiazide)
- Premarin (Conjugated Estrogens,USP)
- Tekamlo (Aliskiren and Amlodipine)
- Tekturna (Aliskiren)
- Tekturna HCT (Aliskiren and Hydrochlorothiazide)
- Vagifem (Estradiol)
- Valturna (Aliskiren and Valsartan)
- Viracept (nelfinavir mesylate)
- Beyaz (Drospirenone and Ethinyl Estradiol and Levomefolate Calcium)
- Cimzia (Certolizumab Pegol)
- Krystexxa (Pegloticase)
- Levaquin (Levofloxacin)
- Levemir (Insulin Detemir [rDNA origin])
- Neupro (Rotigotine)
- Nutropin (Somatropin [rDNA origin])
- Prandimet (Repaglinide and Metformin HCL)
- Safyral (Drospirenone and Ethinyl Estradiol and Levomefolate Calcium)
- Sutent (Sunitinib Malate)
- Synagis (palivizumab)
- Tarceva (Erlotinib)
- Victoza (liraglutide [rDNA])
- Votrient (Pazopanib)
- Xgeva (Denosumab)
- Yasmin (Drospirenone and Ethinyl Estradiol)
- Yaz (Drospirinenone and Ethinyl Estradiol)
- Zegerid (Omeprazole and Sodium Bicarbonate)
Tags: Drug Label Changes, MedWatch
The following article is by Dr John Cannell of the Vitamin D Council.
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.
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.
Tags: autoimmune disease treatment, idiopathic throbocytopenia purpura, ITP, vitamin D