Until relatively recently, people spent most of their time outdoors, working and playing under the sun. During the transition from a hunter/gatherer, to an agrarian (farming), to an industrial (factory), to post-industrial(computer) based society, we have increasingly become building-dwellers. This creates several health-related problems.

 

Hormonal Disharmony

The hypothalamus is the master hormonal regulator. Light enters the body through the retino-hypothalamic pathway: through the eyes, converted to nerve impulses, and transmitted to the hypothalamus. Hormonal secretion corresponds with “circadian” (24-hour) rhythms, which are activated by sunlight and timed to light/darkness cycles. Night shift work and sunlight deprivation hamper hormonal output and promote a sub-optimal hormonal state. This is described in Chapter 20 of my book.

 

Low Serotonin

Sunlight is the main stimulus for serotonin production. Serotonin is a neurotransmitter in the brain that regulates mood and is associated with many forms of depression. Sunlight deprivation causes serotonin levels to decline. Those most affected by this develop “seasonal affective disorder.” SAD is a form of depression caused by low sunlight exposure during wintertime when days are shorter - and is more prevalent at high latitudes and in persistently cloudy areas.

What happens when you have low-serotonin depression? You reach for a snack (or a drink) to raise serotonin levels. What’s worse, we tend to reach for processed carbohydrate/sugar laden food because subconsciously we’ve learned that these make us feel better (and trigger the sharpest rise in serotonin). As you may have discovered, the chances of sticking with any diet when you’re depressed are nearly zero.

Some people take prescription “serotonin-reuptake inhibitor” (SRI) drugs to raise serotonin levels. In many cases the underlying cause of low serotonin is sunlight deficiency. This is why full-spectrum light therapy is used to treat seasonal depression and appetite disorders. Incandescent or fluorescent bulbs – which light homes and workplaces – do not emit all the necessary wavelengths and are insufficiently bright to make a positive difference in your mental health. The most potent and effective source of full spectrum light is above you every day – the moment you step outside.

 

Vitamin D and Sun Hormone

Sunlight is critical for production of vitamin D (cholecalciferol). When solar ultraviolet radiation in the wavelength range of 290-320 nanometers (UVB) strikes exposed areas of the body it is converted in the skin to vitamin D, which then can be converted in the liver and kidneys to a hormone-like substance named 1,25-dihydroxyvitamin D3 (the technical name for “calcitriol,” or as I call it, “sun hormone”). Research shows that vitamin D deficiency is widespread and contributes to many modern maladies. Exciting discoveries have been made recently about the effects of vitamin D and the consequences of deficiency  - particularly in connection with immunity, osteoporosis, heart disease, and cancer. Sunlight gets a bad rap for promoting skin cancer while sunlight exposure is correlated with lower overall cancer rates.1-4 

Pancreatic and prostate cancer, for example, are more common at higher latitudes where less sunlight is available and people cover a larger proportion of their skin with clothes during wintertime. These are the same areas historically prone to rickets, a vitamin D deficiency disease that causes “bow legs” and other skeletal deformities. Also, the incidence of rickets, pancreatic and prostate cancer, and vitamin D deficiency is higher among people with heavily pigmented skin. Dark skin is more resistant to ultraviolet radiation, therefore, dark-skinned folks require more sunlight than light-skinned folks to produce a given amount of vitamin D.5,6 This likely explains why the incidence of vitamin D deficiency is higher among African Americans than among Americans of European descent and may also explain why some diseases occur more frequently (while others, such as melanoma, occur less frequently) in dark-skinned individuals.7,8 A study performed at the Tufts University USDA Human Nutrition Research Center on Aging examining the vitamin D levels of 90 women 20-40 years of age at 42° north latitude (in the Boston area) found that vitamin D levels were lowest in Feb/March and highest in June/July – and lower for black women at all times tested. 9

When a dark-skinned person whose ancestors originated in equatorial Africa or the Caribbean islands moves to Detroit, Chicago, or Canada they increase their risks for a variety of health problems. While dark skin is a predisposing trait in vitamin D deficiency, Caucasians who spend a disproportionate amount of time indoors – particularly at high latitudes – are not much better off. Cold weather is the equalizer because when nearly all skin is covered-up by clothing, black and white alike are at elevated risk of D vitamin deficiency.

Sunlight-induced vitamin D production is maxed-out prior to skin reddening, so burning is not an issue if you’re sunning for vitamin D rather than to tan. Avoiding the sun altogether to avoid skin cancer is a misapplied and ill-advised preventative measure. Optimal health, mental and physical, is incompatible with sunlight deprivation. Basel and squamous cell skin cancer are related to cumulative sunlight exposure, and these forms are rarely life-threatening. Melanoma, which occurs deeper in the skin and spreads aggressively, is not related to cumulative sunlight exposure. People who shun the sun and burn occasionally are at higher risk of melanoma, while regular moderate sunlight exposure is protective against this lethal form of skin cancer. Equating sunlight with skin cancer, without distinguishing melanoma and absent any consideration of vitamin D, is a dangerously misleading error.

Summary and Recommendation

In many instances, lethargy, depression, and diminished sex drive are symptomatic of sunlight deprivation and, particularly, low vitamin D levels. A correlation between sun hormone and many disease conditions is not only plausible, but also supported by scientific research. Sunlight is the best source, but if you are among the millions of people deficient in vitamin D due to any or a combination of the factors discussed above, supplementation is advised. A recent study indicates that the incidence of vitamin D inadequacy is 36% in otherwise healthy adults, and substantially higher among those seeking medical attention.10

Natural food sources of vitamin D are extremely limited. Cod liver oil is the richest source, followed by salmon, mackerel, and sardines. Fortified milk is a relatively poor source for several reasons - including its high sugar (lactose) content. If you totally avoid the sun you’d need to drink 40 glasses of milk per day according to The Vitamin D Council.

D supplements are becoming popular among women, as doctors increasingly acknowledge that vitamin D is at least as important as calcium for protecting against osteoporosis. In fact, vitamin D is probably more important because, in addition to exerting its own beneficial effect on bone density, D increases absorption and utilization of other bone-reinforcing nutrients – particularly calcium. Vitamin D deficiency causes osteomalacia (bone demineralization). Osteomalacia is sometimes referred to as “adult rickets” and is characterized by bone softening. Long before vitamin D deficiency causes osteomalacia, it contributes to osteoporosis by hindering calcium absorption.11

In a study of women hospitalized for hip fractures, 80% were found to have abnormally low levels of vitamin D.12 At supplemental dosages of 500-1000 i.u. vitamin D, particularly when combined with calcium, has been shown to help protect against bone loss and reduce the incidence of osteoporotic fractures.13-14 In a study of elderly women published in the New England Journal of Medicine, 1634 received 1200 mgs. of calcium and 800 i.u. of vitamin D 1636 received a double placebo. After 18 months, the number of hip fractures was 43% lower among the supplemented group than among the placebo group and bone density of the femur increased 2.7 percent in the supplemented group and decreased 4.6 percent in the placebo group.15

Just as calcium supplementation alone is minimally effective, in order to properly utilize supplemental vitamin D two cofactors must be present: magnesium16-21 and boron.22-28 If you are deficient in either of these two complementary minerals, positive results from vitamin D supplements cannot reasonably be expected. Hormonal Fitness contains 500 i.u. of vitamin D, in addition to a 5 mgs. of boron (my favorite dietary sources include beer and red wine) and 450 mgs. (female)/550 mgs. (male) of magnesium.

500 i.u. is a fraction of how much vitamin D we make as a result of 30 minutes of exposure to summer sunlight. Even at higher dosages, vitamin D supplements are not as effective as sunlight. Sunlight bypasses the digestive system and more directly and reliably raises sun hormone levels. While vitamin D supplements can’t compete with sunlight, 500 i.u. per day of supplemental vitamin D provides valuable insurance against vitamin D deficiency; and at this level and higher (up to 2000 i.u.) supplemental vitamin D has produced positive results in clinical trials of osteoporosis and other vitamin D-deficiency-related disorders.

Scroll down to read the report below on vitamin D and heart disease, contributed by Professor Phil Jacklin, Ph.D. (Yale, Phi Beta Kappa) and President of the Smart Life Forum.

Also, please click here to read Vitamin D and Cancer – the Harvard Study. It is authored by a highly distinguished group including Walter Willet, M.D. and Chairman of the Harvard School of Nutrition and Public Health. His research was the primary impetus behind the newfound public awareness of the dangers of trans fats, and he has spearheaded the effort to get trans fats out of the grocery store. If you don’t wish to read the entire article, published in the Journal of the National Cancer Institute (April 2006) the bottom line is: Dr.Willet estimates that vitamin D deficiency in the U.S. population causes 85,550 unnecessary deaths by cancer each year. Help get the word out, this can save lives.

 

1. Lefkowitz ES, Garland CF. Sunlight, Vitamin D, and Ovarian Cancer Mortality Rates in US Women. Int J Epidemiol 1994;23:1133.

2. Garland FC, et al. Geographic Variation in Breast Cancer Mortality in the United States: A Hypothesis Involving Exposure to Solar Radiation. Prev Med 1990;19:614.

3. Gorham ED, Garland FC, Garland CF. Sunlight and Breast Cancer Incidence in the USSR. Int J Epidemiol 1990;19:820.

4. Garland CF, Garland FC. Do Sunlight and Vitamin D Reduce the Likelihood of Colon Cancer? Int J Epidemiol 1980;9:227.

5. Loomis WF. Skin-Pigment Regulation of Vitamin-D Biosynthesis in Man. Science 1967;157:501.

6. Cornish DA, Maluleke V, Mhalanga T. An Investigation into a Possible Relationship between Vitamin D, Parathyroid Hormone, Calcium and Magnesium in a Normally Pigmented and an Albino Rural Black Population in the Northern Province of South Africa. Biofactors 2000;11:35.

7. Nesby O-Dell S, et al. Hypovitaminosis D Prevalence and Determinants among African American and White Women of Reproductive Age: Third National Health and Nutrition Examination Survey, 1988-1994. Am J Clin Nutr 2002;76:187

8. Haris SS, et al. Vitamin D Insufficiency and Hyperparathyroidism in a Low Income, Multiracial, Elderly Population. J Clin Endocrinol Metab 2000;85:4125

9. Harris SS, Dawson-Hughes B. Seasonal Changes In Plasma 25-Hydroxyvitamin D Concentrations Of Young American Black And White Women. Am J Clin Nutr 1998;67:1232.

10. Holick MF. High Prevalence of Vitamin D Inadequacy and Implications for Health.
 Mayo Clin Proc 2006;81:353.

11. Lips P. Vitamin D Physiology. Prog Biophys Mol Biol 2006;92:4.

12. Simonelli C. The Role of Vitamin D Deficiency in Osteoporosis and Fractures. Minn Med 2005;88:34.

13. Meier C, et al. Supplementation with Oral Vitamin D3 and Calcium during Winter Prevents Seasonal Bone Loss: A Randomized Controlled Open-Label Prospective Trial. J Bone Miner Res 2004;19:1221.

14. Capuy MC, et al. Combined Calcium and Vitamin D3 Supplementation in Elderly Women: Confirmation of Reversal of Secondary Hyperparathyroidism and Hip Fracture Risk: The Decalyos II Study. Osteoporosis Int 2002;13:257.

15. Chapuy MC, et al. Vitamin D and Calcium to Prevent Hip Fractures in the Elderly Women. N Engl J Med 1992;327:1637.

16. Risco F, Traba ML. Bone Specific Binding Sites for 1,25(OH)2D3 in Magnesium Deficiency. J Physiol Biochem 2004;60:199.

17. Sahota O, et al. Vitamin D Insufficiency and the Blunted PTH Response in Established Osteoporosis: The Role of Magnesium Deficiency. Osteoporos Int 2006;17:1013.

18. McCoy H, Kenney MA. Interactions Between Magnesium and Vitamin D: Possible Implications in The Immune System. Magnes Res 1996;9:185

19. Carpenter TO. Disturbances of Vitamin D Metabolism and Action During Clinical and Experimental Magnesium Deficiency. Magnes Res 1988;1:131.

20. Rude RK, Et Al. Low Serum Concentrations Of 1,25-Dihydroxyvitamin D in Human Magnesium Deficiency. J Clin Endocrinol Metab 1985;61:933.

21. Medalle R, Waterhouse C, Hahn TJ. Vitamin D Resistance in Magnesium Deficiency. Am J Clin Nutr 1976;29:854.

22. Hegsted M. Effect of Boron on Vitamin D Deficient Rats. Biol Trace Elem Res 1991;28:243.

23. Hunt CD, Herbel JL, Idso JP. Dietary Boron Modifies the Effects of Vitamin D3 Nutrition on Indices of Energy Substrate Utilization and Mineral Metabolism in the Chick. J Bone Miner Res 1994;9:171.

24. Hunt CD. The Biochemical Effects of Physiologic Amounts of Dietary Boron in Animal Nutrition Models. Environ Health Perspect 1994;102:35S.

25. Dupre JN. Effects of Dietary Boron in Rats Fed a Vitamin D-Deficient Diet. Environ Health Perspect 1994;102:55S.

26. Samman S, et al. The Nutritional and Metabolic Effects of Boron in Humans and Animals. Biol Trace Elem Res 1998;66:227.

27. Kurtoglu V, Kurtoglu F, Coskun B. Effects of Boron Supplementation of Adequate and Inadequate Vitamin D3-Containing Diet on Performance and Serum Biochemical Characters of Broiler Chickens. Res Vet Sci 2001;71:183.

28. Miljkovic D, Miljkovic N, Mccarty MF. Up-Regulatory Impact of Boron on Vitamin D Function -- Does it Reflect Inhibition Of 24-Hydroxylase? Med Hypotheses 2004;63:1054.

 

By Phil Jacklin, Ph.D.

 Paradigms and Paradoxes

Before we start, let’s talk about paradigms and paradoxes. A paradigm is a set of assumptions, concepts, and practices that constitutes a way of viewing reality.  The current paradigm is that heart disease is caused by a combination of genetics, hypertension, diabetes, cholesterol, smoking, obesity, inactivity, and diet.  A paradox is a fact that contradicts the paradigm.

The Framingham Risk Equation is an attempt to use the most reliable risk factors in the paradigm to predict who will get heart disease.  When they applied it to British men for ten years, they found 84% of the heart disease occurred in the men classified as low risk!  Furthermore, 75% of the men classified as high risk were still free of heart disease ten years later. It seems the equation is missing a few variables. 

BMJ. 2003 Nov 29;327(7426):1267.

There are several interesting heart disease paradoxes.  How well do you know them?  Good time for another quiz.

1.  The French Paradox is the observation that cardiovascular disease is relatively low in France, despite high intakes of saturated fats.

A.     True

B.     False

True.  Perhaps the best known of the cardiovascular disease paradoxes, the most common explanation is that the French love red wine and the antioxidants it contains.  It was first described in 1987, before the dermatologists scared the French out of their bikinis.  The rates of cardiovascular mortality in France are much lower in the South and West than in the North.  One of the world’s best vitamin D researchers, Dr. Marie Chapuy, found that vitamin D levels of healthy adults in France follow that same pattern, with a mean level of 38 ngs/ml in the sunnier and drier South and West, but less than half that (17ngs/ml) in the colder, rainier, and more polluted, North.

Arch Mal Coeur Vaiss. 1987 Apr;80 Spec No:17-21. 

Hypertension. 2005 Oct;46(4):645-6. Epub 2005 Sep 12.

Hypertension. 2005 Oct;46(4):645-6. Epub 2005 Sep 12.

Osteoporos Int. 1997;7(5):439-43.

 

2.  The Israeli Paradox is the observation that cardiovascular disease is high in Israel despite a high consumption of polyunsaturated omega-6 fats.

A.                 True

B.                 False

True. According to the current paradigm, polyunsaturated fats contained in vegetable seed oils are supposed to lower the risk of heart disease.   However, high consumption of these oils doesn’t appear to prevent the Israelis from dying from heart attacks.  Israel does, despite its sunny weather, have a high incidence of vitamin D deficiency.  Average vitamin D levels among healthy adults in Lebanon, right next door, are only 9.7 ngs/ml - dangerously low.  Healthy Jewish mothers, especially orthodox ones, have low vitamin D levels.  (If you are wondering how the pro-inflammatory omega-6 oils could ever help heart disease, one possibility is these oils dissociate vitamin D from its binding protein, making more free vitamin D available. Apparently, the Israelis don’t have enough vitamin D in their blood to dissociate).

Isr J Med Sci. 1996 Nov;32(11):1134-43.

Isr Med Assoc J. 2004 Feb;6(2):82-7.

J Bone Miner Res. 2000 Sep;15(9):1856-62.

Isr Med Assoc J. 2001 Jun;3(6):419-21.

J Steroid Biochem Mol Biol. 1992 Sep;42(8):855-61.

 

3  The Italian Paradox is the observation that a population of heavy smokers has a low incidence of cardiovascular disease.

A.     True

B.     False

True.  The overall death rate from cardiovascular disease in Italy, a country of heavy smokers, is relatively low.  Before you say it is the olive oil and wine, ask yourself where olive trees and grapevines grow – in the sun.  However, at least two good studies show vitamin D levels in Europe are a paradox, the closer a European lives to the equator, the lower their vitamin D level.  Nevertheless, an Italian study showed healthy Roman blood donors had robust vitamin D levels of 48 ngs/ml in the summer.  Even average postmenopausal Italian women reached 36 ng/ml in the summer.  Anyone who has traveled in Italy, know that most Italians love the sun.  As the old Italian proverb points out: “Where the sun does not go, the doctor does.”

QJM. 2000 Jun;93(6):375-83.

Br J Nutr. 1999 Feb;81(2):133-7.

 

4.   The Northern Ireland Paradox is the observation that a population with a very high incidence of coronary heart disease does not have high rates of the expected risk factors.

A.     True

B.     False

True.  In fact, the age adjusted mortality for coronary artery disease was more than four times higher in Belfast than in Toulouse, France, despite almost identical coronary risk factors.  There were 761 deaths per 100,000 in Belfast compared to 175 in Toulouse.  This is hard to explain, given the current paradigm of heart disease.  Of interest, Belfast is at 54 degrees latitude, at sea level, and has 257 rainy days per year.  Toulouse is eleven degrees closer to the equator, its altitude is 500 feet closer to the sun, and Toulouse only has 74 rainy days per year.  Lots more vitamin D in Toulouse!

QJM. 1995 Jul;88(7):469-77.

QJM. 1998 Oct;91(10):667-76.

Weatherbase, Belfast

Weatherbase, Toulouse

           

5.  The Indian Paradox is the observation that a high prevalence of coronary artery disease in urban Indians is associated with low saturated fat intake.

A.     True

B.     False      

True. Researchers found that a low saturated fat diet did not prevent heart disease in the citizens of the brass-works-polluted city of Moradabad in northern India.  The authors did not mention that air pollution dramatically lowers vitamin D levels.

J Am Coll Nutr. 1998 Aug;17(4):342-50.

Arch Dis Child. 2002 Aug;87(2):111-3.

 

6.  The Swedish Paradox is the observation that the strong association between cold weather and heart disease in Sweden is not explained by the usual risk factors.

A.                 True

B.                 False

True.  Researchers tried to explain why higher annual cardiac mortality is associated with residence in colder regions of Sweden.  Try as they might, the authors could not support the current paradigm for heart disease.  They failed to mention that cold weather is a marker for low vitamin D levels, as outdoor activity in cold weather is both curtailed and requires extensive clothing.

Scott Med J. 1991 Dec;36(6):165-8.

The point of these six paradoxes is simple.  Our current paradigm for understanding heart disease is incomplete.  One or more major causes of heart disease remain unknown.  One theory - the theory that vitamin D deficiency is a major cause of heart disease – may explain these paradoxes.

 

7.  Robert Scragg, Associate Professor in Epidemiology at the University of Auckland, first proposed that vitamin D deficiency plays a role in cardiovascular disease.

A.                 True

B.                 False

True.  For the last 25 years, Dr. Scragg has been trying to convince anyone who would listen that vitamin D explains many of observations about heart disease.  These include the facts that heart disease is higher at higher latitudes, lower altitudes, in the winter, in African Americans, in older, inactive, and in more obese patients.  Remember, vitamin D blood levels are lower at higher latitudes, lower altitudes, in the winter, in African Americans, in older, inactive, and in more obese patients.  Altitude is the least known of these associations.  The age adjusted mortality for heart disease in the USA showed a striking inverse correlation with altitude in 1979, before the sun scare.  American populations at the highest altitude had about half the heart disease of sea level populations.  Thirty-five years ago, Leaf observed that most of the long-lived populations in the world reside at high altitude.

Int J Epidemiol. 1981 Dec;10(4):337-41.

J Chronic Dis. 1979;32(1-2):157-62.

Sci Am. 1973 Sep;229(3):44-52.

 

8.  Dr. Scragg showed that higher vitamin D levels are associated with lower risk for heart attack.

A.                 True

B.                 False

True.  In 1979, the Tromso Heart Study found corrected vitamin D levels showed the same thing.

Int J Epidemiol. 1990 Sep;19(3):559-63.

Br Med J. 1979 Jul 21;2(6183):176.

 

9.  Dr. Scragg is such a good scientist, he then published a study which seemed to disprove his theory.

A.     True

B.     False

 True.  He discovered that a single oral dose of 100,000 units of vitamin D had no effect on risk factors (serum cholesterol or blood pressure) five weeks later.  This seemed to disprove his theory, but he published the data anyway, always a mark of a good scientist. We now know that 100,000 units are a small dose and that such “stoss” therapy is not physiological. Such a small single dose will raise vitamin D levels for a month or two, but then they rapidly fall towards baseline and would have little physiological effect five weeks later.

 Eur J Clin Nutr. 1995 Sep;49(9):640-6.

 

10.  Zittermann points out that vitamin D reduces vascular smooth muscle proliferation, reduces vascular calcification, decreases parathormone levels, reduces C reactive protein (CRP) and other markers of inflammation, and decreases renin, all of which should prevent or treat heart disease.

A.                 True

B.                 False

True.  He discusses most of the evidence that exists, tying heart disease to vitamin D deficiency.  A vitamin D theory of heart disease explains the excess cardiovascular deaths at high latitude, low altitude and during the winter.  Furthermore, it explains the higher incidence of heart disease in African Americans, older, inactive, and obese individuals as these groups have significantly lower vitamin D blood levels.

Br J Nutr. 2005 Oct;94(4):483-92.

 

11.  In 2003, Zittermann discovered that patients with congestive heart failure (CHF) have very low levels of vitamin D.

A.                 True

B.                 False

True.  Furthermore, he found that a protein (NT-proANP), which is a predictor of CHF severity, was inversely associated with vitamin D levels.

J Am Coll Cardiol. 2003 Jan 1;41(1):105-12.

 

12.  Blood cholesterol measurements are worse at higher latitudes, lower altitudes and in the winter.

A.                 True

B.                 False

True.  The effects of latitude on cholesterol seen in the first study are quite remarkable.  In the Greek study, total serum cholesterol for both men and women were significantly lower at higher altitude in spite of similar diets.  The seasonal variations in cholesterol are well known and not explained by seasonal dietary changes.

QJM. 1996 Aug;89(8):579-89.

J Epidemiol Community Health. 2005 Apr;59(4):274-8.

J Clin Epidemiol. 1988;41(7):679-89.

Chronobiol Int. 2001 May;18(3):541-57.

 

13.  Blood pressure is higher at higher latitudes, lower altitudes, in the winter, in African Americans, in the aged, and in the obese.

A.                 True

B.                 False

True.  High blood pressure is one of the strongest predictors of heart disease.  Here, six facts about hypertension can be explained by one theory: vitamin D.

Hypertension. 1997 Aug;30(2 Pt 1):150-6.

Ann Hum Biol. 2000 Jan-Feb;27(1):19-28.

Harv Health Lett. 2005 Sep;30(11):8.

 

14.  Diabetes is more common at higher latitudes, at lower altitudes, in African Americans, in the aged and the obese.  Both blood sugar and hemoglobin A1C are higher in the winter.

A.                 True

B.                 False

True.  Six final facts that can be explained with one theory: vitamin D.

Eur J Epidemiol. 1991 Jan;7(1):55-63.

Nutrition. 2001 Apr;17(4):305-9.

Diabetes Res Clin Pract. 2005 Aug;69(2):169-74. Epub 2005 Jan 12.

Diabetologia. 1982 Apr;22(4):250-3.

Am J Epidemiol. 2005 Mar 15;161(6):565-74.

 

15.  Two studies show vitamin D significantly reduces C reactive protein (CRP), which may be a better predictor of heart disease than LDL cholesterol. 

A.                 True

B.                 False

True.  The Belgian study found a significant effect on CRP even though their high-dose vitamin D group only got 500 units a day.

QJM. 2002 Dec;95(12):787-96.

J Clin Endocrinol Metab. 2003 Oct;88(10):4623-32.

 

16.  The risk for total mortality is significantly lower in subjects with high vitamin D levels.

A.                 True

B.                 False

True.  However, the study is in Finnish and has not been translated into English (author communication).

Seppanen R, Marniemi J, Alanen E, Impivaara O, Jarvislo J, Ronnemaa T, et al. Ravinnon ja seerumin vitamiinit ja kivennaisaineet vanhusten kuolleisuuden ennustajina.  Suom Laakaril 2000;42:4255-60 [Finnish].  Reported in Nutr Metab Cardiovasc Dis. 2005 Jun;15(3):188-97.

 

17.  It is now a proven scientific fact that vitamin D both prevents and treats heart disease.

A.                 True

B.                 False

False.  Like so may other fields of vitamin D research, we lack the definitive interventional trials that would settle the point.  It would be simple for the National Institutes of Health to fund a study giving physiological doses of real vitamin D (5,000 units of cholecalciferol) to heart disease patients for a year and see if CRP, proinsulin, blood pressure, cholesterol, body weight, heart attacks, or death rate decreases. 

We will have to wait years for science to find out if vitamin D prevents and/or treats heart disease. While you are waiting, you have a choice. You can wait vitamin D deficient (levels less than 40 ngs/ml) or you can wait vitamin D sufficient (levels around 40-60 ngs/ml). The choice is yours - another Pascal’s Wager - this time you are betting your heart.

Also, while you wait for more studies, remember that vitamin D should be obtained daily, not monthly or weekly. It should be obtained physiologically, not in an all-then-none manner, as would happen if you took 100,000 units one day a month and nothing the other 29 days. It appears likely that high blood levels followed by low blood levels may do harm. The reason is that falling blood levels reset the enzymes maintaining intracellular levels of activated vitamin D, resulting in low intracellular levels.

Int J Cancer. 2004 Sep 1;111(3):468; author reply 469.


Vitamin D should be consumed the way the human genome consumed it during its evolution in subequatorial Africa, a steady amount every day. If you live down south, you can go in the sun for a few minutes every day. If you live up north you can sun in the warmer months and use a sunlamp or take real vitamin D (cholecalciferol) in the winter. Adults in the north could take one 5,000 unit capsule a day in late fall, winter, and early spring, less in the late spring and early fall, and none in the summer months - depending on your sunning habits.  Children over 50 pounds need two of the 1,000 unit capsules every day in the colder months while children under 50 pounds need about 1,000 units in the colder months. Few people need to take oral vitamin D in the summer unless you are a sunphobe. Get enough vitamin D every day to maintain stable vitamin D blood levels (25-hydroxy-vitamin D) around 50 ngs/ml, year-around.

Last question: should patients dying from heart disease be allowed to die vitamin D deficient? According to the current paradigm, the answer is yes. At least, none of the cardiologists I know even bother to check a vitamin D level. Given the scientific literature, that’s a bit paradoxical.