[solarmeter®]

The TRUTH and rebuttle to this garbage:

January 22, 2008


The health benefits of vitamin D supplementation and fortification greatly outweigh the health risks

William B. Grant, Ph.D.,1 Cedric F. Garland, Dr. P.H., F.A.C.E.2


1 Sunlight, Nutrition, and Health Research Center (SUNARC)
P.O. Box 641603
San Francisco, CA 94164-1603, USA
www.sunarc.org
wbgrant@infionline.net
1-415-409-1980 – voice and fax (call first)


2Department of Family and Preventive Medicine 0631C, University of California San Diego, La Jolla, CA


Draft version
For: BioEssays as a letter to the editor (already looking for it)

Text: 606 (600 permitted)

References: 10




In his recent essay, Trevor G. Marshall explores how vitamin D supplementation may be contributing to the current epidemics of obesity and chronic disease [1]. Unfortunately, he has overlooked many important papers that disagree with his hypothesis. This letter points out some of the omissions.

The health benefits of vitamin D3 have been reviewed recently [2]. The benefits for bone health have been known for nearly a century. Benefits for cancer, infectious diseases, autoimmune diseases, and metabolic diseases have been identified in the past three decades.

Starting in the 1980s, largely observational evidence mounted that solar ultraviolet-B (UVB) irradiance and vitamin D reduce the risk of many types of cancer [3]. Based on observational studies, it is estimated that 1500 and 3600 International Units (IU) of vitamin D3 are required for a 50% reduction in risk of colorectal and breast cancer, respectively [4]. A recent randomized, double-blind, placebo-controlled study involving post-menopausal women in Nebraska found a 77% reduction in all-cancer incidence between the ends of the first and fourth years [5], thereby adding strong support to the observational studies.

As mentioned in [1], vitamin D enhances the innate immune system through induction of human cathelicidin, LL-37. LL-37 fights both bacterial and viral infections. A recent post-hoc analysis of vitamin D3 supplementation for post-menopausal women living in New York State found substantial benefits in reducing the common cold and influenza for 800 IU/day, and very strong benefits for 2000 IU/day [6]. Benefits also appear to be strong for septicaemia [Grant, submitted] and enteric viral infections such as norovirus [Grant, submitted], both of which are more common in winter than in summer.

Autoimmune diseases appear to arise from an improper immune response to viral infections. Since LL-37 reduces the risk of viral infections, it follows that LL-37 also reduces the risk of autoimmune diseases such as multiple sclerosis. The well-known increase in prevalence of multiple sclerosis with increasing latitude supports this hypothesis.

There is also a growing body of literature that low vitamin D status is a risk factor for many metabolic diseases including hypertension, type 2 diabetes, and cardiovascular disease [2]. A recent observational study found that vitamin D deficiency is associated with incident cardiovascular disease [7].

Admittedly there are some cases where vitamin D supplementation may be contraindicated. One of these cases is granulomatous diseases such as sarcoidosis where local production of 1,25-dihydroxyvitamin D (calcitriol) can leak into the serum and dysregulate calcium metabolism [8].

The current vitamin D3 fortification of food in the United States contributed 250-300 IU/day to the average American person. This amount is too low to have much of a beneficial effect on cancer. Intake or production of vitamin D3 of between 1000 and 2000 IU/day seems required for optimal health, and will raise serum 25-hydroxyvitamin D (calcidiol) levels to 40-60 ng/mL [4,6,9]. There have not been more prospective vitamin D supplementation studies for the simple reason that there is little profit to be made from selling vitamin D3 (a year’s supply of 1500 IU/day costs less than $20 U.S.). However, with the very positive benefits found in several recent studies, there should be more studies reported in the near future. In the mean time, most people will obtain a health benefit from increased vitamin D3 fortification and supplementation.

The rising prevalence of obesity in the United States can be traced to two primary factors: replacing fat with simple carbohydrates in processed food and the farm subsidy program for corn and soybeans in particular, which leads to overproduction of energy-dense foods [10].

Disclosure
WBG receives funding from the UV Foundation (McLean, VA), the Vitamin D Society (Canada), and the European Sunlight Association.

References
1. Marshall TG. Vitamin D discovery outpaces FDA decision making. Bioessays. 2008;30(2):173-182.
http://TrevorMarshall.com/BioEssays-Feb08-Marshall-Preprint.pdf
2. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266-81.

3. Garland CF, Garland FC, Gorham ED, Lipkin M, Newmark H, Mohr SB, Holick MF. The role of vitamin D in cancer prevention. Am J Public Health. 2006;96(2):252-61.

4. Garland CF, Grant WB, Mohr SB, Gorham ED, Garland FC. What is the dose-response relationship between vitamin D and cancer risk? Nutr Rev. 2007;65(8 Pt 2):S91-5.

5. Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007;85(6):1586-91.

6. Aloia JF, Li-Ng M. Re: epidemic influenza and vitamin D. Epidemiol Infect. 2007;135(7):1095-6; author reply 1097-8.

7. Wang TJ, Pencina MJ, Booth SL, Jacques PF, Ingelsson E, Lanier K, Benjamin EJ, D'Agostino RB, Wolf M, Vasan RS. Vitamin D Deficiency and Risk of Cardiovascular Disease. Circulation. 2008 Jan 7; [Epub ahead of print]

8. Hewison M, Burke F, Evans KN, Lammas DA, Sansom DM, Liu P, Modlin RL, Adams JS. Extra-renal 25-hydroxyvitamin D3-1alpha-hydroxylase in human health and disease. J Steroid Biochem Mol Biol. 2007;103(3-5):316-21.

9. Cannell J, Hollis B, Zasloff M, Heaney R. Diagnosis and treatment of vitamin D deficiency. Expert Opin Pharmacother. 2008;9(1):107-118.

10. Pollan M. The Omnivore’s Dilemma; Natural History of Four Meals. Penguin Press, New York. 2006. 430 pp.

Reserve:

Falk S, Kratzsch J, Paschke R, Koch CA. Hypercalcemia as a result of sarcoidosis with normal serum concentrations of vitamin D. Med Sci Monit. 2007 Nov;13(11):CS133-136.

Grant WB, Garland CF. A critical review of studies on vitamin D in relation to colorectal cancer. Nutr Cancer. 2004;48(2):115-23.

Grant WB. Hypothesis-Ultraviolet-B irradiance and vitamin D reduce the risk of viral infections and thus their sequelae, including autoimmune diseases and some cancers. Photochem Photobiol. 2008 Jan 7; [Epub ahead of print]

Mookherjee N, Rehaume LM, Hancock RE. Cathelicidins and functional analogues as antisepsis molecules. Expert Opin Ther Targets. 2007;11(8):993-1004.

Mullin GE, Dobs A. Vitamin D and its role in cancer and immunity: a prescription for sunlight. Nutr Clin Pract. 2007 Jun;22(3):305-22.


Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006 Jul;84(1):18-28.

Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA. 2005 May 11;293(18):2257-64. Review.




Med Sci Monit. 2007 Nov;13(11):CS133-136.Links
Hypercalcemia as a result of sarcoidosis with normal serum concentrations of vitamin D.

Falk S, Kratzsch J, Paschke R, Koch CA.
Division of Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany.
BACKGROUND: Hypercalcemia can occur in patients with granulomatous disorders such as sarcoidosis, and is commonly related to high serum 1,25-dihydroxyvitamin D (OHD) concentrations. CASE REPORT: We here report a 68-year-old man with a history of mild renal insufficiency who presented with hypercalcemia (serum calcium of 3.11 mmol) and normal 1,25-OHD levels (38 pg/ml, RIA/IDS, Boldon, UK, measuring both 1,25-OH D2 and D3). Imaging and laboratory investigations were suggestive of sarcoidosis. After hydration and prednisone therapy (40 mg/day) for 7 days, serum calcium dropped to 2.7 mmol and 1,25-OHD levels to 13.4 pg/ml. Six weeks after prednisone therapy, serum calcium was 2.41 mmol (normal) and 1,25-OHD 6.2 pg/ml (low). Computed tomography of the chest showed shrinkage of the right hilar mass. CONCLUSIONS: This case illustrates that hypercalcemia can occur in granuloma-forming disorders such as sarcoidosis in the setting of inappropriately normal (and not elevated) 1,25-OHD levels. Contributing factors may include dehydration, increased uptake of oral calcium and/or decreased calcium excretion, especially in mild renal insufficiency. Therapy of choice are hydration and glucocorticoid (prednisone) therapy. In this setting, prednisone may lead to a decline of activated mononuclear cells (in the lung and lymph nodes) that are able to produce extrarenal PTH-independent 1,25-OHD.