Something To Laugh About and More On Vitamin D

It's often been said that laughter is the best medicine, and I couldn't agree more. Therefore, I dedicate today's blog to a funny video that a friend shared with me and my wife. I hope you enjoy it as much as we did.

http://www.youtube.com/watch?v=PypsMk_0QxY&feature=youtube_gdata_player

For those hungry for some science, here's a funny, not in terms of humor, but in terms of being a somewhat ridiculous study that was reported on a few days ago. I have no doubt that the results of the study are already being used to feed the recent hysteria about Vitamin D deficiencies.

Why? I'll get to that in a moment but let me first share what happened with an email I received from a service of the U.S. National Library of Medicine and National Institutes of Health that reported on this new study.

Last week, I took exception to material in another article from the same source that implied that calcium could only be obtained from dairy products, which is far from the truth. Here's a link to another government resource listing many other food sources, albeit not all healthy ones. And while dairy products dominate the list, there are other excellent sources as well. Cut and paste: http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

When I wrote to the source of the email, the response was that they simply reported what they received from the newswires. I told them that such a response was a cop-out and that they had a responsibility as a government service to make sure that the information they were disseminating was accurate. We went back and forth in a few emails and the net result was that I received an email from the head librarian in which he essentially disavowed any responsibility for the information being forwarded. I found that quite disappointing.

Nevertheless, I knew that henceforth I have to be careful with anything I received from this source. With that in mind, let’s address the headline of the article in a recent email I received from the same source, which was titled, “Low Vitamin D Levels Linked To Weight Gain in Older Women.” Now any reasonable person would conclude based on this headline that women with Vitamin D deficiencies are generally gaining weight as a result of their deficiency. Well, that’s not what the studied showed.

Quoting from the email, “The researchers followed more than 4,600 women aged 65 and older over the course of nearly five years. The study found the women with low levels of vitamin D gained about two more pounds during that time than those with normal levels of the vitamin.” How about that? A whole two pounds more. Is that consistent with what you expected from the headline? Two whole pounds gained over 5 years? I’m sure we all expected that from the headline, right? That’s not all. Which women do you think gained the weight? It turns out to quote the article again, it was the “women [who] generally weighed several pounds more to begin with, the researchers noted.” So the heavier women gained more weight. Not a big surprise that an overweight person would gain more weight as is often the case.

But that’s not the funny part I referenced earlier.

Here’s the funny, or not so funny, part. The article goes on to say, “Although most of the women in the study were not trying to lose weight, over the course of the study 27 percent of the women lost more than 5 percent of their body weight and 12 percent gained more than 5 percent of their body weight, the researchers noted.”So despite the vitamin D deficiency or perhaps because of it, which apparently according to this study was present in 78% of the tested women, more women actually LOST weight than gained it.

Accordingly, why wasn’t the headline “Low Vitamin D Levels Linked To Weight Loss in Older Women” or even “Low Vitamin D Levels Linked To Weight Gain, Weight Loss, and No Weight Change in Older Women.” Now that would have been an accurate headline.

So was the article a total loss? No. Here’s the only semi-reasonable comment coming from the article and I quote, “"Our study only shows an association between insufficient levels of vitamin D and weight gain," study author Dr. Erin LeBlanc, an endocrinologist and researcher at the Kaiser Permanente Center for Health Research in Oregon said. "We would need to do more studies before recommending the supplements to keep people from gaining weight. Since there are so many conflicting recommendations about taking vitamin D for any reason, it's best if patients get advice from their own health care provider."

Finally, a little bit of sense although given the 27% of women actually lost weight it would be more logical to suggest that Vitamin D supplementation should NEVER be used as a weight loss tool.

So as I often recommend, please don’t trust headlines, even from government sources. You need to, at a minimum, read the entire article and ideally, look at the actual study if you want to even get close to the truth. Of course, even looking at the study is not a safe bet because so many studies are done by unreliable sources with an agenda, who manipulate the science, if it even is actual science, in their favor.

So what’s a person to do? Send the article or study it to me. I love to look at interesting studies and dissect them looking for the truth. Consider me your personal truth seeker.

Dr. Oz's Vitamin D Recommendation Doesn't Hold Up To USPSTF Review

Yesterday, a patient came to see me again because she was concerned that I had recommended that she stop supplementing with Vitamin D. I had previously told her that she should get her Vitamin D (and fish oil) naturally from eating Wild Alaskan Salmon and other fish rich in Omega-3 fatty acids such as halibut, cod, sardines, anchovies, herring, etc. at least three times a week, and from fortified foods such as unsweetened almond milk.

She had just been to another doctor for the thyroid disorder I had diagnosed who suggested she reinstate her taking Vitamin D. She wasn't happy in general with this particular endocrinologist, but wanted to discuss what to do next with her thyroid disease and his advice about Vitamin D.

I explained again that my recommendation was based on the prevailing science and the fact that she had a very good level of Vitamin D based on her bloodwork.

As fate would have it, in a draft recommendation released yesterday, the United States Preventive Task Force (USPSTF), confirming my recommendation, said there is no value for postmenopausal women in taking supplements up to 400 IU of vitamin D and 1,000 mg of calcium.

The USPSTF also found the evidence too scant to draw conclusions about vitamin D supplements, at any dose and with or without calcium, for cancer prevention in adults.

It was based on an evidence review finding that "in postmenopausal women, there is adequate evidence that daily supplementation with 400 IU of vitamin D3 combined with 1,000 mg of calcium carbonate has no effect on the incidence of osteoporotic fractures. However, there is inadequate evidence regarding the effect of higher doses of combined vitamin D and calcium supplementation on fracture incidence in postmenopausal women."

At the same time, the USPSTF found, doses at or below 400 IU of vitamin D and 1,000 mg of calcium increase the risk of kidney stones, albeit to a small degree.

But with no benefit from the supplements, even the small risk of harm is enough to tip the balance against them at these low doses, the group indicated.

The bottom line is there are no clear benefits of taking Vitamin D and calcium supplements and you can get all the Vitamin D your body needs, in the absence of deficiency, from natural sources including sun exposure, Wild Salmon, other fishes, etc.

Nevertheless, Dr. Oz repeatedly recommends Vitamin D as a top anti-aging supplement.

What are you going to follow: Science or marketing?

MDPrevent

What Do You Put Your Faith In?

Many things are done on the basis of faith. Religion is one example, relationships are another.  However, proper practice of medicine should be based on evidence not blind faith.

Making the headlines yesterday was the United States Preventive Services Task Force recommendation that doctors discontinue routine testing for Prostate Specific Antigen (PSA) in healthy men. This recommendation was based on two studies, one which showed no difference between men tested versus not tested, and the second study which showed that among tested men, there were many false positives that led to further unnecessary testing e.g. biopsies, which led to complications e.g. infections.

Not surprising, many urologists and oncologists came out against this don't test recommendation. What's the answer? My view is that if you have symptoms, you should test, and if not, you should not test. I believe this is true in many medical situations not because I have an opinion but because the facts support that conclusion.

Yesterday, I exchanged a number of correspondences with a lady on LinkedIn regarding the need to test everyone for Vitamin D deficiencies.  She emphatically believes that it is necessary to test everyone because most people who don't take Vitamin D supplements are deficient; I don't agree.  My reason for not agreeing is because that's not what the science shows. As I wrote the other day about Vitamin D and The Endocrine Society, the facts are inconclusive as to the effects of mega-dosing with Vitamin D. This lady insisted that she needed twice the normal lower level of Vitamin D to be healthy. It's not surprising that so many people are confused by what they need because rumors and false information often circulate unabated without correction about supplements. You may remember my blog titled Supplementum, The New Religion. It was a parody of Americans' growing blind faith in supplementation in the absence of compelling evidence.

I can understand why many put their faith in things that aren't true. We sometimes just want to believe; sometimes we just need to believe.  Oftentimes belief is a good thing if it gives you solace or helps you navigate an often confusing world. That's all fine as long as such belief does not lead to dangerous situations and irreversible harm. While I believe that it is important to be vigilant, I don't believe that it is proper to test for no reason. In the Longevity Project book, the authors concluded that a little bit of neuroticism is good for your long term health, but chasing diagnoses in the absence of symptoms is full blown neuroticism and that's not healthy.

My biggest issue with supplement marketers is that they give people false hope by promoting science fiction as fact, when there are better solutions available that won't be pursued because of reliance on placebo-like products. If people had all the facts, the supplement market would be a fraction of its size and it knows it. That's why it fights the FDA with everything it has because the FDA wants the facts to be known.

Faith works, but when it comes to your health, I think you would be better off relying on evidenced based medicine. I know I do.

Vitamin D Benefits Still Inconclusive

http://mdprevent.blogspot.com/2012/03/whats-big-deal-about-vitamin-d-lot.html


On Tuesday March 20, 2012 I wrote a blog (link above) about Vitamin D. Vitamin D, like other vitamins, is an essential part of human functioning. Over the past couple of years its value has been so overblown that many supplement marketers have advocated mega-dosing with it. Many of my first-time patients present with multiple forms of Vitamin D which they have added over the years, which they don't seem to need.

In 2010, the Institute of Medicine explicitly warned against mega-dosing with Vitamin D, but the message apparently never got out to the general public probably because the marketers are very successful in out-shouting reliable medical sources most of the time.

So here's my attempt to get the latest news out. The Endocrine Society, the world's oldest, largest, and most active organization devoted to research on hormones and the clinical practice of endocrinology, put together a task force to look at Vitamin D and basically concluded that "large randomized trials are needed to determine whether vitamin D can prevent or treat cancer, diabetes, cardiovascular disease, and other non-skeletal disorders."


The task force examined more than 300 studies of vitamin D's role in tissues other than bone and published their report as an official "scientific statement" in the June issue of Endocrine Reviews.

The task force's most important conclusion was that although many of the studies offered tantalizing hints that the substance helps maintain health in a variety of ways, there remains "little hard proof."

So there you have it. You don't need to supplement with Vitamin D in the absence of a known deficiency, but if you insist, take into consideration the amounts of Vitamin D you get from sunlight (15-20 minutes a day typically reported to produce the recommended daily allowance), wild salmon (2-3 times recommended amounts), Almond milk, regular milk and other dairy products, etc. and adjust accordingly to avoid mega-dosing.

Please share this with your friends so that everyone has the facts and aren't ruled by the fiction.

An educated patient is my favorite type.

Another Reason To Go Wild Over Wild Salmon

Too many doctors have bought into the hyperbole regarding vitamins and other dietary supplements, often recommending them without all the facts. Some even go so far as to sell them without regard to consequences. Don't even get me started again about Dr. Oz.

For example, there has been such a preponderance of media coverage about Vitamin D deficiencies that you would think that everyone has a Vitamin D deficiency. It's simply not true. We often search without success.

Nevertheless, by now, unless you have been living in a cave, you've most likely heard the Vitamin D Story. If not, it goes like this. We need Vitamin D and we can get from 15 minutes a day of sun exposure. However, because some people don't get much some exposure for good parts of the year based on their geographic location, or because of they are afraid of sun exposure due to skin cancer, or because as people age they produce less Vitamin D from sun exposure, we need to supplement with Vitamin D.

Although products like Almond milk and regular milk are fortified with Vitamin D, as are a number of other processed foods like cereals, many still recommend supplementation in case we are not getting enough.  I do not recommend supplementation in the absence of known deficiency and because there is a viable alternative.

There is a great source of Vitamin D that also offers other potent nutrients and that is Wild Salmon. I sing the praise of Wild Salmon so much you'd think I owned a fish company. Well, I don't. But I am a huge fan because of the medicinal benefits of Wild Salmon. First, the wild variety has 4 times the Vitamin D than the farm raised variety. A 3.5 ounce Wild Salmon steak also has over 200% of the recommended daily allowance of Vitamin D.  In addition, Wild Salmon also has the omega-3s (EPA and DPH) which have cholesterol lowering, anti-inflammatory, and apparent pro-brain health effects. Finally, Wild Salmon is a great source of protein for your diet.

Cod liver oil is another great source of Vitamin D, but it has its own set of issues so I recommend Wild Salmon any day over it. In fact, consuming Wild Salmon 3 to 4 times a week would be wise.

So isn't it time you got rid of your Vitamin D pills and consumed a natural source of it?

I Just Don't Know

Today's blog has two parts and thought-trains.

Part 1

I typically don't read Glamour Magazine. However knowing my penchant for all things related to vitamins, my youngest daughter was delighted to share an article she came across in the magazine. The gist of the article were the responses from three experts to a question regarding the appropriateness of taking multivitamins after recent studies have suggested they may be harmful.

The first response came from a PhD who works at the Fred Hutchinson Cancer Research Center whose response was basically no, they are not needed. The second response came from a MD and professor of prevention at a Harvard teaching hospital who basically said no except in specific cases like folate during pregnancy shown to avoid birth defects. The third response came from Dr. Michael Roizen, the Chief Wellness Officer of the Cleveland Clinic who basically said yes because people don't eat good diets.

I was infuriated that he answered as he did. I met the man a little over a year ago when I visited the Cleveland Clinic in Ohio. The purposes of the trip was to explore partnership with him and the Clinic regarding my new prevention initiative. (For full disclosure, there were a number of subsequent conversations and correspondences after the trip as I vigorously pursued the opportunity. Eventually, however, I walked away because I found their terms of partnership to be highly lopsided.)

Notwithstanding, during the trip, I had an opportunity to speak to Dr. Roizen in privacy. During that time, which was relatively early in my auditing the field of prevention, I asked Dr. Roizen which dietary supplements he believed stood out among all others and that he would personally recommend for daily consumption. His list included baby aspirin, fish oil, probiotics, Vitamin D, and turmeric.

On the surface, it's not a bad list. Under the right set of circumstances, the first four have clear benefits. However, he did not know my medical history and therefore it was probably imprudent to him to make such specific recommendations, but then again I asked and he was happy to oblige. (Read more about this in part 2 of this blog.) 

For example, aspirin can prevent platelet aggregation (thereby decreasing blood clots) and some studies show some benefit in preventing colon cancer, but aspirin can also increase gastric bleeding and can lead to the development of macular degeneration. Given my history of gastric ulcer, aspirin is a tough choice.

One of my recent blogs dealt with fish oil at length, so just to summarize, its not the panacea everyone has made it out to be and given the option, eating fish like Wild Alaskan Salmon beats it hands-down.

Another one of my blogs dealt with probiotics and an extensive body of research supports my assertion that probiotics have no benefit if you have a generally healthy gut. They can be beneficial when taking antibiotics and when dealing with inflammation of the bowels, but they are not useful routinely.

Many people are apparently (I say apparently because no one knows for sure) Vitamin D deficient because of lack of sun exposure. However, treating anything on presumption, I believe is a mistake. First of all, many foods are fortified with Vitamin D so even though one does not get much sun exposure one is not necessarily deficient. Second, it is easy enough to check for a Vitamin D deficiency and by doing so the result will indicate if you there is a need to supplement and also how much should be taken.

So viewed in their entirety, the first four suggestions from Dr. Roizen were not outlandish as they generally do not cause harm (except for aspirin.) and may be beneficial at times. Tumeric, however, is another story.

Dr. Roizen told me that tumeric prevents Alzheimer's and is good for brain health. Based on Dr. Roizen's suggestion that day (and my hearing him repeat the same advice a few days later on the Retirement  Living TV channel), I naively purchased tumeric and began to add it regularly to my food.

Unfortunately, the highly staining substance turned my teeth bright yellow.  After this disconcerting turn of events, I began intensively researching tumeric and discovered two disturbing facts. First, tumeric has little validated science to support its use for the indications Dr. Roizen asserted. Second, I discovered that in the absence of a black pepper called piperine, tumeric is very poorly absorbed by normal ingestion and so adding it to my food was an effort in futility, except if turning my teeth yellow was my endgame. (By the way, I had to go to a dentist to get rid of the stain.)

Despite these five recommendations, I should have been even more wary of Dr. Roizen's advice when he also practically whispered to me, as to share a well-kept secret, that a certain statin drug had also been shown to decrease the development of Alzheimer's. The whispering should have been the giveaway. All statins are now widely accepted to have no efficacy for such purposes, but I suppose he was depending on some source of information to make his claim.

So now you know why it was disturbing for me to read about Dr. Roizen confidently disseminating advice about multivitamins.

Part 2

After reading Dr. Roizen's comments, I became curious about his background and read his bio available online. I find his credentials to be excellent.  I started thinking why a person like him would spew out what I believe is basically worthless, if not harmful advice, with such certainty. I also started thinking about Dr. Oz, a close friend of Dr. Roizen, (they've authored a number of books together and Dr. Roizen is an adviser to the Dr. Oz Show). Like Roizen, Oz's credentials are also top-notch.

Why, I asked myself, are such erudite men propagating such apparently bad advice about dietary supplements?  Why were they either ignoring or reaching different conclusions that I do from the numerous studies now widely available that show the dangers of dietary supplementation?

So let's assume for a moment that I am reaching the more valid conclusions. If so, what causes them to support the industry? Your first instinct may be to say money, but I dismiss money as the main motivator because I suspect they have already accumulated enough to live quite comfortably and I don't believe that for such distinguished and successful clinicians, it is the end to end all.

So what's the answer? I thought back to a recent episode of The Dr. Oz Show. The guest was a cryptographer (hand-writing expert). As part of the show, the expert analyzed a writing sample from Dr. Oz. His conclusion based on how Dr. Oz forms a wide-open at the bottom scripted 's.' was that this demonstrates that Dr. Oz is very susceptible to the opinion of others. Basically, he concluded that Dr. Oz's popularity stems from his genuine desire to please others. I think most people would agree that this is a pretty good trait to possess.

Let me preface my next comments by stating I have basically no training in psychotherapy. All that follows is conjecture. If you are interested, allow me to speculate why I think this trait of wanting to please others can be problematic especially for physicians in the limelight.

Most physicians are highly intelligent and possess a great deal of accumulated knowledge. Patients know this and expect doctors to be able to routinely answer their questions. However, the body of clinical knowledge, which continues to grow daily, is already far beyond anyone's grasp and that is why there are many specialties and sub-specialties in medicine.

For doctors in the limelight, however, they work hard to create a persona of all-knowing. They want to be viewed as saviors of sorts, able to help both small and wide audiences alike. They never want to disappoint by saying I don't know or I'm not sure.

This realization has caused me to think about my own approach. Until a few weeks ago, I grew more confident in my assertions and more provocative in my conclusions. Then a funny thing happened which I wrote about in another blog. During one of my lectures, an audience member challenged my statements virtually one by one. This forced me to recalibrate and make sure that everything I was saying was defensible. I think my conclusions were generally accurate, but generally was no longer good enough.  I realized after that talk that I was falling into the same trap that I think many before me have fallen into.  I realized that because almost nothing in regards to science can be said with absolute certainty, that it is not fair for someone who can get up and comfortably speak to an audience to assert otherwise.  A speaker should not be expected to always please his or her audience out of expediency if it is the truth that the audience needs and wants.

I believe that many of the doctors like Hyman, Oz, Roizen, etc, say what they say not because it will make them even more money; rather, because it will make their audiences like them more as they offer simple solutions to complicated problems. Some problems require the audience to work hard to accomplish effective solutions and promising quick fixes may be dangerous and inappropriate.

I promise to keep Mark Twain's words close to heart whenever I speak and write. Twain said "it's not what you know that gets you into trouble, it's what you know for sure that does."  Accordingly, as I continue to learn more about dietary supplements, I will work hard to report the facts (if they can be called as much), not my biases. I promise to answer "I just don't know" when that is the most appropriate answer. I think my patients and audiences deserve no less. What do you think?

What's The Big Deal About Vitamin D? It turns out quite a bit.

Vitamin D deficiency has become a hot topic with headlines about its dangers becoming ubiquitous.  Of course, not everyone agrees on what the problem is and how to best treat it.  

Accordingly, I’ve compiled a list of questions and answers to help people navigate through the plethora of issues raised. If you have additional questions, please send me an email at steven.charlap.md@mdprevent.net.

1.      Can sun exposure restore vitamin D to adequate levels?

It is well documented that lack of exposure to sunlight is a major risk factor for vitamin D deficiency. Therefore, you would think if you increased your exposure to sun, you would be all set. That may not be the case according to one doctor.

Here is an excerpt from Medscape News article from today:

"The 'epidemic' in vitamin D deficiency is clearly not from too little sun exposure," and dermatologists can be confident in insisting that their patients continue their sun protection efforts, said Richard Gallo, MD, PhD, here at the American Academy of Dermatology (AAD) 70th Annual Meeting.

"Clearly solar exposure is an influence — there is no doubt about that — but you cannot predictably say that a certain amount of exposure will normalize vitamin D deficiency," said Dr. Gallo, chief of dermatology and professor of medicine and pediatrics at the University of California, San Diego.

I’m not sure that all doctors agree with Dr. Gallo and I still believe that some sun exposure, up to 15 minutes per day (avoid mid-day peak sun) is prudent unless you have already had skin cancer. By the way, your belly skin absorbs sun the best.

2.      What level of Vitamin D defines deficiency?

Serum 25(OH)D - The circulating half-life of 25(OH)D is 2 weeks. This is the best test to determine vitamin D status. A 25(OH)D level of less than 32 ng/mL is considered vitamin D insufficient. A 25(OH)D level of less than 15 or 20 ng/mL have been used to define vitamin D deficiency. Intestinal calcium absorption is optimized at levels above 32 ng/mL. An Institute of Medicine report recommends that patients should have serum vitamin D levels above 20 ng/mL, but the American Endocrine Society sets this level at 30 ng/mL

One issue I have not seen addressed is the fact that Vitamin D is a fat soluble vitamin and blood teats only detect circulating Vitamin D and not fat-stored Vitamin D. I'm not sure if this is significant in diagnosing deficiency, but I would love to hear if you know of anyone who studied this issue.

3.      Who should be tested for Vitamin D deficiency

It is generally recommended to screen only those individuals who are at high risk for vitamin D deficiency, including patients with osteoporosis, malabsorption syndromes, black and hispanic individuals, obese individuals (BMI >30 kg/m²), and those with several other medical conditions.

I don’t agree with these recommendations as I have found deficiency among a much broader group of patients. I don’t believe we should test everyone, but I do believe in testing everyone over the age of 65 who routinely avoids sun exposure.

4.      Is testing of parathyroid hormone (PTH) necessary to make the diagnosis of Vitamin D deficiency?

No, but it is helpful. An elevated PTH is supportive of the diagnosis.

5.      What is the recommended daily intake of Vitamin D?

There is some debate on this one. Some say for adults it is 800 IU, others 1,000 IU, and still others, even higher. I unscientifically vote for 1,000 in absence of deficiency and initial 2000 to restore levels. Others supplement at much higher dosages, even to 50,000 IUs. 

6.      Is Vitamin D toxic at higher levels?

At blood levels of 125 ng/ML, Vitamin D may be toxic and that is why I believe in treating deficiency more cautiously so to avoid going from one unhealthy extreme to another. Doses can always be increased as needed. Obviously, the greater the deficiency, the higher the restorative dose should be.

7.      Which form of Vitamin D--D2 or D3--is best to treat deficiency?

Most scientists agree that D3 (cholecalciferol) is much better but studies support D2 (ergocalciferol) as well. Stick with D3 which everyone accepts.

8.      Is milk a good source of Vitamin D?

Milk may be an unreliable source.  Fortified milk may contain less than the stated amount of vitamin D3 on the product (in some cases less than 80% of the amount), so if the only reason you are drinking milk is for Vitamin D, drink Almond Milk instead which is also fortified.

9.      What foods are good sources of Vitamin D?

Most dietary sources of vitamin D do not contain sufficient amounts of vitamin D to satisfy daily requirements. Foods thought to contain high amounts of vitamin D3 are oily fish, such as salmon and mackerel. A single serving (3.5 oz) of wild-caught salmon has 988 ± 524 IU vitamin D3, an amount that remains unchanged after baking but that decreases by 50% if the salmon is fried in vegetable oil. In comparison, farm-raised salmon has only 25% the content of vitamin D3 found in the flesh of wild salmon, whereas blue fish and mackerel have even lower vitamin D3 levels, at 280 ± 68 and 24 IU, respectively. Vegetables and fruits are not a good source for vitamin D.

The following foods contain the indicated amounts of vitamin D, as reported by the US Department of Agriculture's (USDA's) Nutrient Data Laboratory

·         Fortified milk (8 oz) - 100 IU

·         Fortified orange juice (8 oz)  100 IU

·         Fortified cereal (1 serving) - 40-80 IU

·         Pickled herring (100 g) - 680 IU

·         Canned salmon with bones (100 g) - 624 IU

·         Mackerel (100 g) - 360 IU

·         Canned sardines (100 g) - 272 IU

·         Codfish (100 g) - 44 IU

·         Swiss cheese (100 g) - 44 IU

·         Raw shiitake mushrooms (100 g) - 76 IU

·         Most multivitamins (1 tab) - 400 IU

10.  Does Vitamin D deficiency lead to cancer, both types of diabetes, and increased mortality (death)?

Recent studies suggest that it does, but further study is necessary. Best to stay at healthy blood level regardless of future study results.

11.  Are there prescription drugs that lead to Vitamin D deficiency?

Drugs such as Dilantin, phenobarbital, and rifampin can induce hepatic p450 enzymes to accelerate the catabolism of vitamin D.

12.  Does Celiac Sprue increase risk for Vitamin D deficiency?

Yes, due to malabsorption.

13.  Who is at greatest risk of Vitamin D deficiency?

Elderly homebound and institutionalized individuals don’t get much sun exposure. However, a study from Boston determined that nearly two thirds of healthy, young adults in Boston were vitamin D insufficient at the end of winter. People with dark skin and older people are also at increased risk because their skin does not absorb sunlight as well as others.

14.  Are there any physical findings for Vitamin D deficiency?

Other than rickets and osteoporosis in extreme cases, in adults with a severe vitamin D deficiency, a physical examination can reveal periosteal (outer surface of bone) bone pain. This is best detected using firm pressure on the sternal (chest) bone or tibia (larger leg bone).