April 24, 2011- published April 19, 2011 in the British Medical Journal a meta-analysis of 36,282 postmenopausal women given calcium or calcium with vitamin D found higher incidence (slight but there nonetheless) of MI (myocardial infarction) with or without stroke. The researchers could not determine the exact cause but suggest the acute rise of calcium after supplementation may be a problem as both high and low dose calcium with or without D were implicated. From the study-

"...This would be consistent with the notion that the abrupt change in plasma calcium concentration after supplement ingestion causes the adverse effect, rather than it being related to the total calcium load ingested."

Please make sure, if you do take calcium, as suggested in the Workbook and Preliminary Report, take small amounts throughout the day with food. Also consider that minerals are best in combination, not as singular elements, and consider that vitamin K, minimum daily dose 1 mg. (1,000 mcg), is critical to the health of both heart and bones keeping calcium in bones and out of soft tissues (such as arteries). This information is also in both the workbook and report.

April 2011 A phone call this week is worth posting. A women working with a physician tested 25(OH)D at 36 ng/ml (optimal 40-60 ng/ml) about 3-4 months ago. Her physician told her to take 20,000 IU vitamin D daily. This week she tested 157 ng/ml. Her physician said lots of her patients tested that high and there is no problem and that she should reduce her dose to 5,000 IU. The woman asked my advice. First I suggested she find another physician. Then I suggested she stop all D and sunlight, and lower her calcium intake, until her 25(OH)D reached below 60 ng/ml. I have no idea how long this will take.

If this is your physician or if your physician is like-minded I suggest you, also, get another physician. I also suggest you pay attention to all future health problems and record them chronologically. Report your physician to your local medical board. As I have stated here and in my book there are consequences when ingesting excess vitamin D though among D enthusiasts not yet accepted. One possible consequence is demineralization of bone and/or mineralization of soft tissues. This may happen without any unusual blood work, serum calcium remaining normal. It has been documented by Adams, Kummerow, and Kartha. There are other possible consequences. I will post more later.

The partial article below may be found at news/item.cfm?newsID=2218 What it demonstrates is that D and minerals do not work alone. Just getting enough D is NOT an answer.

Vitamin C protects, maintains healthy bone mass  Dipali Pathak
HOUSTON -- (May 11, 2010) -- Vitamin C, or ascorbate, plays an important role in maintaining bone mass – promoting the balance between old bone resorption and new bone formation, said researchers from Baylor College of Medicine and Lexicon Pharmaceuticals in a report that appears online in the Journal of Biological Chemistry.

"The assumption is that everyone gets enough vitamin C in their diet," said Dr. Kenneth Gabbay, professor of pediatrics – molecular diabetes and metabolism at BCM. "However, multiple studies of large groups of people show that higher intakes of vitamin C are associated with higher bone mass and lower fracture rates. Our study shows that vitamin C or ascorbate is critical to maintaining the homeostasis necessary for healthy bone mass."...

...Gabbay and his colleagues built on the fact that mice can actually synthesize vitamin C, an ability that is lacking in humans. They identified two enzymes critical to this process by providing the building material for vitamin C – aldehyde reductase and aldose reductase. Aldehyde reductase is responsible for 85 percent of vitamin C production and aldose reductase, the remaining 15 percent. Mice bred to lack both enzymes cannot make any vitamin C and develop scurvy, a condition that affects many organ systems including bone.

However, if mice lack only aldehyde reductase, they and their skeletons develop and grow normally on the 15 percent ascorbate or vitamin X generated through aldose reductase until they face a stressor that requires more vitamin C, such as pregnancy or the loss of sex hormones that accompany menopause and aging.

"Then they fall off a cliff and develop early profound osteoporosis," said Gabbay.

His studies (in mice) show that ascorbate or vitamin C both suppresses osteoclasts, which promote bone resorption, and stimulates the development of osteoblasts that make new bone, thus enhancing new bone formation. The constant renewal of bone is crucial to healthy bone architecture.

Many treatments for osteoporosis, including bisphosphonates such as Fosamax and Actonel, suppress the function of osteoclasts, and hence blocks bone resorption and mechanisms of bone repair. Unfortunately, these treatments do not stimulate osteoblast formation and new bone is not made. Many anti-oxidants such as resveratrol (found in red wine) and pycnogenol do the same thing. Only vitamin C affects both sides of the equation – osteoclast suppression and osteoblast development, said Gabbay.

..Most experts recommend vitamin D, calcium, exercise and bisphosphonates to keep bones healthy, said Gabbay. "Vitamin C is never mentioned, whereas it's likely an equally important element for maintaining strong healthy bones" he said. "Our studies necessitate formal studies in patients to evaluate the usefulness of vitamin C therapy in susceptible populations."

Nov. 12, 2009 I read in my inbox that having enough vitamin D absolutely prevents and reverses breast cancer, really. It doesn't. Having adequate vitamin D is healthier overall than not having adequate vitamin D but many persons with low D don t get cancer and persons with adequate D still get cancer, it s just that the risk is lower. In many of the studies the critical point for all outcomes lowered risk is having more than 30 ng/ml which makes sense as optimal remains 40-60 ng/ml. When you read articles or research you have to understand risk . Taking a particular supplement or sunning or any other treatment to prevent anything carries benefits and risks. Having an excellent diet and making sure you get enough but not too much D will LOWER YOUR ODDS but life being what it is, a complex living system, there are many factors known and unknown and no sure things .

I have had several clients over the years with more than adequate vitamin D (between 48-59 ng/ml) and breast cancer. And the studies regarding the reversal of breast cancer with vitamin D were about analogs (artificial molecules created in a lab) used on cancer cells not in actual women. I visited one site proposing such nonsense and read that the ideal amount of 25(OH)D is 60-80 ng/ml and again NO it is not. In our fast times we seem to misread the research and project miracles where they do not exist. I am saddened by the misuse of research and am at a loss to understand why this is occurring. We need vitamin D. When we have between 40-60 ng/ml we are healthier, maybe even happier, but it won t prevent or cure anything, clinically, except secondary hyperparathyroidism and rickets.

Vitamin D with or without calcium has not even been that great at preventing or reversing osteoporosis. There are just too many other things we need to be healthy to lump it all on this one thing . When will we give up the magic bullet? persons promoting high dose and high serum D for the prevention of cancer or any other specific disease really don t understand the human body or vitamin D. Do listen to them with caution, please. And it is true, really, too much D is as unhealthy as too little. Enthusiasm seems to blind us to logic and common sense.

Question: Do I have to worry about not getting enough UV-B exposure (for Vitamin D), during the winter, since I live in Denver, which, obviously is 5,280 above sea level? I apologize for bothering you, but, I could not find this answer anywhere on the Internet. Obviously this answer will make a big difference on how much Vitamin D supplements I need to take.

Answer: Yes and No. Each 1,000 feet in elevation equals about 1 degree closer to the equator (from where you are) so Denver, latitude 39.46° at altitude 5,280 ft would have a similar UV-B to a location at 33-34°, not all that UV-B rich. Reflective snow in winter would make mid-day more intense but as to available D it just isn't t all that much because UV-B is less in winter in all locations more distant from the equator. Only locations 30° or closer to the equator have consistently intense UV-B. Whether using sunlight or supplements the only way to know how much you need is to record how much you get and test 25(OH)D.

Supplemental D or sun exposure should not be based on location because your need for D depends on much more than that; your skin color, your age, your sunning habits, your diet, your genes, your weather (clouds, fog and some urban pollution, aka urban ozone, block UV-B). The only way to know how much D you have and how much D or sun you need and if the supplemental D or sun, or tanning bed you are using is working is TESTING. TEST and RETEST, don t guess. Your HMO, your physician, lef.org or ZRT Labs provide you a means of monitoring your D. Use your resources.

Question: Since we cannot really live half of the year in the tropics, we thought about using UV lamps, but it is hard to know which type can reliably deliver the correct amount of UVB rays. Have you investigated specific brands etc? Unfortunately, there is not much help to be had from local doctors, as they usually have a deep prejudice against UV lamps instilled by dermatologists.

Answer: Wolff tanning beds (beds that use Wolff lights) may be used to replete vitamin D. These beds are often referred to as "20 minute" beds. The amount of UV-B is similar to summer sun BUT the danger is in staying too long. You make all the D you will make BEFORE your skin alters in any way, even the very lightest of pink . Tanning actually reduces the amount of D you are able to produce on your skin. Light skinned persons would need 7-10 minutes, maybe less, to produce significant amounts of D. A responsible proprietor and NEVER staying longer than you need are keys to safe use of tanning beds. Further instructions on safe use of beds may be found in the Sunlight packet below. A note of caution- any exposure to UV light lowers the amount of vitamin A and vitamin C in your skin .If you decide to use light to produce vitamin D consider how much extra A and C you need to keep your skin happy and healthy.

Question: ...have read (looked at) several articles on this subject. They give good descriptions of the beneficial effects. But so far, I have not seen (Yes, I m sure it is there, somewhere!) a listing of times considered advantageous. And yes, there are many factors. For instance, time of year, condition of the sky etc but the one I'm interested in is time for an average person, at a reasonable latitude, like 35 °, and importantly the % coverage of the sunlight recipient! If a person is nude they require less time than if one is in normal clothing and a person dressed like an Eskimo might as well stay inside. Can you give any benchmarks for a person such as me. And yes, I have another disadvantage, I m 86 years old!

Answer: Some researchers suggest a particular amount of sunlight is equivalent to a particular dose of D. I have been testing 25(OH)D in several hundreds of clients since 2000 and found no correlation of either D intake or sun exposure and 25(OH)D that was useful long term as a rule or guideline for others.

Aging skin produces significantly less D even when UV-B is present and there is the issue of excess sun exposure, level of vitamin A present in skin, level of cellular anti-oxidants including vitamin C, and the incidence of skin cancer. Life requires we balance benefit and risk of all our behaviors.

At 38° north a very light skinned person might need 10-12 minutes per side, mostly naked, between 10AM and 2pM, to raise D to between 50-60 ng/ml. By December 25(OH)D may drop below 40 ng/ml. If the location was in a city (with city haze) vitamin D production might be much less.