Monday, December 21, 2009

Vitamin D: A retraction--I got it all wrong

Vitamin D is much more complex than I have indicated earlier. The only thing I can say about the reversed pattern (active D higher than inactive D) is that it appears to be a marker for Lyme disease and/or inflammation--perhaps a very good marker.

Much research has been done on vitamin D. All of it is based on measurement of the inactive form, vitamin D hydroxy 25, which correlates with stored vitamin D. Yes, vitamin D has anti-inflammatory properties, but this may not be a bad thing. It affects cytokines andT-cell activation. But contrary to previous comments, it is active vitamin D that increases production of an anti-microbial peptide: cathelicidin. (Past statements that active D tilts the immune system from Th1 to Th2--causing production of anti-microbial peptides is wrong). The binding of active D to receptors modulates the genetic expression of complex proteins. VDRs (vitamin D receptors) are found in many organs in the body, including: brain, heart, skin, gonads, prostate and breast. Vitamin D receptors are found on a variety of immune cells, including: monocytes, B-cells and activated T-cells. It also has effects on dendritic cells. Vitamin D toxicity is very rare, even in patients with very high levels of active vitamin D, the 1,25 dihydroxy form.

Anti-inflammatory effects of D may lower the risk cancers, autoimmune disease, diabetes, heart disease and others. Recent research has shown that vitamin D is required to activate the histocompatibility gene, HLA-DRB 1501. This activation is necessary for the immune system to differentiate between self and non self in a select group of patients.

A link between vitamin D and MS has been shown. Perhaps the lack of MS in tropical climes
is not related to the absence of Bb and other infectious agents, as some have postulated, but due to higher levels of D from birth on.

The main source of D is sun light. Increased melanin decreases UVB penetration through the skin needed for conversion of D. It has been shown the black skin increases the risk of prostate cancer in the US but not in Africa--perhaps evidence of D's cancer fighting effects.

The Canadian Cancer Society has recommended that all it's citizens supplement with 1000 units of D daily.

D supplements are generally in the form called D3. This is the same form obtained from sun exposure. There are many forms of D and it's metabolism is very complex. Clinically, we only measure D in its stored and active forms.

In these numerous studies, only stored vitamin D is measured. Some doctors on the "cutting edge" have suggested that vitamin D hydroxy 25 levels are optimal at 75 (normal
32 to 100). But they are not looking at lab values I see in my practice. The range for normal active vitamin has been expanded, (10 to 75).

Many of my patients typically have stored vit D levels of 12--very low-- and active vit D levels of 100-- still high even though the range has changed.

In some way, the body--the immune system ostensibly, is trying to rectify the problems related to the infection (maybe). After treatment many patients have D levels in the normal ranges. This varies: some patients have D levels which drop across the board.

It now seems to me that judicious supplementation of D may in fact be very useful. Levels need to be monitored. the use of Benicar to inhibit renal conversion of inactive to active D may be a bad idea. Our bodies are pretty smart: let them balance the levels as needed. If active levels are above 100 I am somewhat hesitant to recommend D supplements. I have no basis for this. Again, vitamin D toxicity is difficult to attain. Reported cases have only been reported in individuals taking 40,000 units daily over a period of time.


Max said...

What do you say about this then? :

Very interesting albeit depressing article.

According to it BB (check tables s2) alters the expression of quite a few genes . Including 50 fold VDR transcription downregulation

Lori said...

Some LLMD's want patients to take up to 5,000 oof Vit D per day

girl mark said...

Great article- could you please go back to your other Vitamin D posts and add a link to this 'retraction' in the comments or the main article? Blogger's software search function is lousy, so someone might not find all the articles if they just do a search while trying to figure out the facts behind the Marshall recommendations for instance.

bobcat said...

Thank you for posting! I never looked very far into the arguments various people have made claiming that supplementing with D3 was a not-so-good idea. Frankly, I ignored those arguments, because it just didn't seem logical that avoiding a basic vitamin like that could help anyone (not saying you advocated that...I haven't read a lot of your older posts so I'm not sure).

I figured...I feel better when I get sun. I feel best in the summer, worst in the winter. My nails are stronger when I take D3. Having many risk factors for osteoporosis, I'd be remiss NOT to supplement with it.

The studies touting D3's benefits just keep rolling in.

Can you tell I'm a D3 fan? :)

Renee K said...

D3 works for me too, when my level was 18 I was sick with colds etc , now on 6000 daily trying to raise my levels and haven't had any URIs even though out and about and exposed. Having a difficult time achieving an adequate level while fighting the Lyme.

Staying out of sunlight and avoiding vitamin D never sounded natural to me.

Thanks for the update.

Mike said...

here is a site with plenty of information on vitamin D: The site also offers a new micro tablet version of vitamin D

Momcat1011 said...

Jan Ehrchen et al. reported 1{alpha},25(OH)2D3 treatment of L. major infected macrophages demonstrated a vitamin D receptor (Vdr) dependent inhibition of macrophage killing activity. Further analysis showed that this was a result of decreased production of nitric oxide by 1{alpha},25(OH)2D3-treated macrophages due to Vdr-dependent up-regulation of arginase 1 expression, which overrides NO production by Nos2. When analyzing the course of infection in vivo, we found that Vdr-knockout (Vdr-KO) mice were more resistant to L. major infection than their wild-type littermates. This result is in agreement with an inhibitory influence of 1{alpha},25(OH)2D3 on the macrophage mediated host defense. Thus, as stated high level of D3 support the Bb infection. If high levels of D3 are in existence prior to infection this might explain why patients are not cured by three weeks of antibiotics. One potential treatment to get the cellular immune system up and running is to inhibit arginase activity until Bb infection is contained. There must be a hormonal signal favoring arginase production—insulin would be good candidate to look at.

Twin said...

Perhaps consider that vitamin D is a seasonal timing indicator. Lyme disease occurs in temperate climates and host animals are less active in the Winter. Vitamin D above a certain threshold may be a trigger for BB to go active and attempt to enter the blood (say in a white tailed deer host) so as to be transfered by tick vector to...another host.

A good trick would be to use this (if its true) as part of a therapy. (A:) Perhaps ceftriaxone + mega dose of Vit D.
Or perhaps the opposite,(B:) Vit D suppressed to keep BB inactive.

Momcat1011 said...

One can suppress vitamin D with protease inhibitors-- a common OTC compound is NAC

Leann said...

So why do out D levels go up and then plummet back down while taking the exact same amount of D?
My D went from 63 to 23 and now my doctor wants to put me on prescription D, 50,000 IUs 2x a week. Last time I tried this, it went to toxic levels in 3 months. So how much is too much D?

Also I felt great for about 2 months while my D level was extremely high. When it came back within normal range, I became very ill again. Why?

ProvidentialHealing said...

Very fascinating. What would you say about this in the light of Gc-MAF (vitamin D binding hormone)?