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Vitamin D news - New suggested label messages for vitamin D supplements in the UK

12 February 2013

The Department of Health in the United Kingdom has issued new recommendations for label messages for vitamin D supplements.
The new suggested labeling targets specific populations, some at higher risk of vitamin D deficiency than others.
For instance, the Department of Health suggested wording specifically targeted for people who do not get much sun exposure. “The Chief Medical Officer recommends that people who are not exposed to much sun, [for example those who cover their skin, who are housebound or confined indoors for long periods] should take a daily supplement of 10μg of vitamin D.” 10μg is equivalent to 400 IU of vitamin D.
The Department of Health also made suggested labeling messages for children 6 months to 5 years old, pregnant and lactating mothers, and to people over the age of 65. The wording for these targeted groups can be found on their website: http://www.dh.gov.uk/health/2013/02/vitamin-d-supplements/
Source
Department of Health. Department recommends product label messages on vitamin D supplements for at risk groups. February, 2013

Low vitamin D linked to sepsis, mortality

http://www.vitamindcouncil.org/low-vitamin-d-linked-to-sepsis-mortality/

25 January 2013

Research reported at the Society of Critical Care Medicine meeting found that people who are vitamin D deficient have an increased risk of developing sepsis – a severe blood infection – and an increased risk of death if they develop sepsis.

Kenneth Christopher, MD, of Brigham and Women’s Hospital in Boston reported that people who had low vitamin D levels prior to being admitted to the hospital were significantly more likely to develop sepsis after hospitalization compared to patients with normal vitamin D levels. Among patients who developed sepsis, the odds of dying within 30 days was greater for people with deficient or insufficient vitamin D blood levels.

Dr Christopher and colleagues analyzed data from 3,400 adult patients who received care in the ICU at two Boston hospitals from 1998 to 2011 who had vitamin D blood test up to a year prior to hospitalization. Within 12 months, 26% of patients died. The authors found that the mortality rate was higher for those with sepsis, reaching 44.6%. Vitamin D deficiency pre-admission was significantly associated with sepsis, an association which remained after correcting for confounders.

Another study presented by Bryan Nguyen, MD, of Loma Linda University in California offered support to the Boston research.

Dr Nguyen and colleagues uncovered a related link between vitamin D status and an increased mortality risk in patients with sepsis. They analyzed the link between vitamin D levels in the first 72 hours of hospitalization and 30-day mortality in patients with sepsis. The study included 91 emergency room patients who were admitted to the ICU. Eleven percent of the patients died within 30 days.

The patients who died had significantly lower vitamin D levels at admission, compared to those who survived the first 30 days (p=0.04). Interestingly, parathyroid hormone levels were significantly higher among patients who died within the first 3 days in the ICU.

The researchers are cautious to celebrate vitamin D as a cure-all for sepsis, but they support its potential ability to expedite recovery time.

Nguyen concludes that the study “does suggest that 1,25(OH)₂D may be a viable therapeutic target in the design of future sepsis clinical trials while we're trying to tease out the various mechanisms of vitamin D deficiency in these patients."

Source

Neale T. Low vitamin D tied to poor sepsis outcomes. Medpage Today. Jan 23, 2013.

Page last edited: 25 January 2013

Vitamin D: Most popular vitamin of 2012

http://blog.vitamindcouncil.org/2013/01/19/vitamin-d-most-popular-vitamin-of-2012/

Posted on January 19, 2013 by Dr William Grant

There were 3600 publications with vitamin D in the title or abstract in 2012 according to PubMed.gov. This brings the total number of publications on vitamin D listed at PubMed to 33,800 (http://www.ncbi.nlm.nih.gov/pubmed). This total compares to 35,100 on vitamin C or ascorbic acid, 21,700 on vitamin E, 19,100 on vitamin A, 17,600 on folate, and 12,000 on vitamin B12. However, since the beginning of 2000, there have been 20,500 publications on vitamin D but only 16,300 publications on vitamin C or ascorbic acid. Thus, vitamin D is the most popular vitamin even though strictly speaking it is not a vitamin. Instead, it is a necessary hormone that can be made in the body through the action of ultraviolet-B (UVB) light. However, it can also be obtained orally through the diet or supplements.

Top 16 Vitamin D Papers of 2012

The following list of top vitamin D papers for 2012 was selected from a search at PubMed.gov at the end of 2012. The list started out with 60 of candidate papers. This list was then sent to a panel of vitamin D researchers and advocates, who added a few more papers, then voted on the entire list. The final list has papers from a variety of health effects. Many other fine papers could not be included due to space limitations.

4,000 IU vitamin D3 was of great help during pregnancy

A topic that generated considerable interest this year was the role of vitamin D during pregnancy. In a pair of papers, researchers from the Medical University of South Carolina discussed the findings and implications of their randomized controlled trial of vitamin D supplementation during pregnancy.^{1, 2} Over 300 women were enrolled in the study. Women were assigned to take supplements containing 400, 2000, or 4000 IU/d vitamin D3 or a placebo. No adverse effects were found such as hypercalcemia or hypercalcuria. This study found that it took 4000 IU/d to raise serum 25-hydroxyvitamin D [25(OH)D] levels to about 40 ng/ml (To convert to nmol/l, multiple ng/ml by 2.5.), a nearly optimal level of 1,25-dihydroxyvitamin D. 1,25-dihydroxyvitamin D is the active or hormonal metabolite of vitamin D which among other things controls the expression of several hundred genes. (See Hossein-nezhad and Holick [2012] for a summary of the effects of vitamin D on fetal development.³) In the study, those taking the higher vitamin D doses had significantly reduced risk of primary Cesarean section delivery and pre-eclampsia. Other adverse pregnancy outcomes occur with vitamin D deficiency such as premature delivery and low birth weight, but too few women were enrolled in this study to find statistically significant results on these conditions.

Mounting evidence that vitamin D deficiency is an important risk factor for autism

A study from Saudi Arabia examined the relation between serum 25(OH)D level and anti-myelin-associated glycoprotein (anti-MAG) auto-antibodies in autistic children near the age of eight years.⁴ There was a very strong inverse relation between the two levels (r = -0.86).

Low vitamin D during pregnancy is associated with childhood language impairment

A study in Perth, Australia measured serum 25(OH)D levels at 18 weeks into pregnancy, and then measured language impairment of the offspring at 5 and 10 years of age. It found that women with serum 25(OH)D levels below 18 ng/ml had children with twice the risk of clinically significant language difficulties compared to those with 25(OH)D levels above 28 ng/ml.⁵ Exactly why is not currently known, but there are many possibilities. It is noted that in the United States in the early 2000s, white women of childbearing age had mean 25(OH)D level of 26 ng/ml while black women of childbearing age had mean 25(OH)D level of 14 ng/ml. Both of these levels are low by current standards. As explained below, skin color is directly relevant to serum vitamin D levels produced by exposure to sunlight.

Higher vitamin D is associated with lower all-cause mortality rates

A topic of interest at the other end of life was the relation of mortality rate to serum 25(OH)D levels. A meta-analysis of 11 observational studies and 60,000 individuals found a reduction in risk over about 10 years for highest vs. lowest category of 25(OH)D level of mortality of 29%.⁶Comparing graded levels of intake, the reduction in risk was 14% for an increase of 5 ng/ml, 23% for an increase of 10 ng/ml, and 39% for an increase of 20 ng/ml in plasma levels of 25(OH)D, starting from a median of ~11 ng/ml. The participants starting with the lowest levels of serum 25(OH)D received the greatest benefits. Those who started with higher serum levels, closer to optimal (30-40 ng/ml), received less benefit from additional vitamin D. This relation between starting serum 25(OH)D levels and health outcome is not surprising because it is similar to many other health studies. Since 25(OH)D levels likely changed over the duration of the studies, and some participants died of unrelated causes, the actual effect of serum 25(OH)D level on mortality rate is greater than these estimates.

And less cardiovascular disease

Cardiovascular disease is an important contributor to mortality rates. A study of 11,000 patients in Kansas was reported. The patients had a mean age of 58±15 years, a body mass index of 30±8 kg/m², and a mean serum 25(OH)D level of 24±14 ng/ml.⁷ Serum 25(OH)D levels below 30 ng/ml was significantly associated with several cardiovascular-related diseases, including hypertension, coronary artery disease, cardiomyopathy, and diabetes. After a period of 5.5 years, those with serum 25(OH)D levels below 30 ng/ml had twice the mortality rate of those with higher 25(OH)D levels.

And less risk of diabetes mellitus type 2

In a 2.7-year study of 2000 prediabetics, participants with the highest third of 25(OH)D levels (median, 30.1 ng/ml) had a reduction in risk of 28% for developing diabetes mellitus type 2 compared with participants in the lowest third (median, 12.8 ng/ml).⁸

. . . and less diabetes mellitus type 1 (T1DM)

An observational study on insulin-dependent diabetes mellitus (T1DM) was based on 1000 U.S. military service personnel who developed this disease between 2002 and 2011.⁹ They had provided blood samples between one and ten years prior to developing T1DM. They were carefully matched with another thousand service personnel who did not develop T1DM. There was a reduction in risk of 78% for developing T1DM for those with serum 25(OH)D levels above 24 ng/ml compared to those with levels below 24 ng/ml. This finding is highly statistically significant and is one of the strongest studies of its type.

Fewer bacterial and viral infections

The effect of vitamin D in reducing risk of infections is a topic of increasing interest. Vitamin D reduces risk of infections primarily by strengthening the innate immune system, primarily by inducing production of cathelicidin, a polypeptide with antimicrobial and antiendotoxin properties. It also shifts production of cytokines, a type of cell signaling molecule, away from proinflammatory ones, and has a number of other actions on both the innate and adaptive immune system.¹⁰ While the effects of vitamin D have been found mostly for bacterial infections, some have also been reported for viral infections such as influenza, HIV, and hepatitis C.¹⁰ In a supplementation study in Sweden involving 140 patients with frequent respiratory tract infections (RTIs) using 4000 IU/d vitamin D3, those in the supplementation group increased their serum 25(OH)D level to 53 ng/ml while those in the placebo group had levels near 27 ng/ml.¹¹ Those taking vitamin D3 had a 23% reduction in RTIs and a 50% reduction in the number of days using antibiotics.

The benefits of vitamin D in reducing risk of cancer

One of the important and well-documented effects of vitamin D is reduced risk of cancer and increased survival after cancer diagnosis. There were 400 publications on vitamin D and cancer in 2012 according to PubMed.gov. Evidence from ecological, observational and laboratory studies have identified over 15 types of cancer for which higher solar UVB light and/or serum 25(OH)D levels are associated with reduced risk. Two of the papers are especially noteworthy. One, a study from Norway involving 658 patients with either breast, colon, lung, or lymphoma with serum 25(OH)D levels determined within 90 days of cancer diagnosis were followed for up to nine years.¹² Compared to those with levels 32 ng/ml had a reduction in risk for dying from cancer of 66%. To a cancer patient, this would be a lifeline.

Another cancer paper reported the results of supplementation with 4000 IU/d vitamin D3 of those with low-grade biopsy-assayed prostate cancer.¹³ Forty four patients successfully completed the one-year study. Twenty four of the subjects (55%) showed a decrease in the amount of cancer; five subjects (11%) showed no change; 15 subjects (34%) showed an increase. In comparison, with a historical group of 19 patients, only 4 (21%) had reductions in the amount of cancer, 3 (16%) showed no changes, and 12 (63%) showed an increase in cancer. Thus optimal vitamin D supplementation appears to be useful for treating those with cancer.

Falls and fractures

The classical role of vitamin D is to regulate calcium and phosphate absorption and metabolism, leading to strong bones. A pooled analysis of 31,000 persons (mean age, 76 years; 91% women) participating in randomized controlled trials of vitamin D supplementation who developed ~1000 incident hip fractures and ~3800 nonvertebral fractures found that those with the highest intake (median 800 IU/d; range 792-2000) had a 30% reduction in risk of hip fracture and a 14% reduced risk of nonvertebral fracture.¹⁴ The role of vitamin D in neuromuscular control also plays an important role in reducing risk of falls and fractures.

Skin pigment adapts slowly to changed ultraviolet environment

Jablonski and Chaplin have published a series of papers on human skin pigmentation and its relation to solar ultraviolet radiation (UVR).¹⁵ Their primary thesis is that human skin pigmentation has adapted to UVR conditions where a group of people live for 50 generations, or about a thousand years. UVR from mid-day sunlight produces vitamin D, which provides important protection against many diseases, but sunlight also causes skin cancer and destruction of folate. Dark skin protects against free radical production, damage to DNA, cancer, and loss of folate. Thus, dark skin is best in the tropical planes regions while pale skin is best at high latitude regions. Those with skin adapted to UVB between 23° and 46° have the ability to tan, which is an adaptation to seasonal changes in solar UVB doses. However, in recent times, people have moved or traveled to regions where their skin pigmentation is not suited to the local UVR conditions. They discuss three examples: nutritional rickets, multiple sclerosis and melanoma. Their abstract concludes with this observation: “Low UVB levels and vitamin D deficiencies produced by changes in location and lifestyle pose some of the most serious disease risks of the twenty-first century.”

Vitamin D levels for traditionally living Africans

A study on traditionally living Africans near the equator provides information on “normal” 25(OH)D levels. A paper was published on serum 25(OH)D levels of the Masai and the Hadzabe living near 4° S in Tanzania.¹⁶ They have skin type VI (very dark), wear a moderate amount of clothing, spend the major part of the day outdoors, but avoid direct exposure to sunlight when possible. The mean serum 25(OH)D levels of Maasai and Hadzabe were 48 (range 23-67) ng/ml and 44 (range 28-68) ng/ml, respectively. This finding suggests that serum 25(OH)D levels in the range of 40-50 ng/ml may be optimal for human health, which is generally consistent with observational studies for a number of health outcomes.

Vitamin D is made by exposure to sunlight to a significant degree only when the sun is 45 degrees or more above the horizon. At the latitudes of North America and Europe, this is summer midday sunlight between the hours of 11 a.m. and 3 p.m. In the early morning or late afternoon, light-skinned individuals may tan but they hardly get any vitamin D from sunlight. And in the winter, nobody gets much vitamin D from the sun. This explains the health benefits of taking supplements of vitamin D.

Summary and Conclusion

Thus, the evidence that serum 25(OH)D levels above 30-40 ng/ml are required for optimal health continues to mount. It takes 1000-4000 IU/d vitamin D3 to reach these levels in the absence of significant UVB exposure. The evidence comes from a variety of studies including observational and laboratory studies and randomized controlled trials (RCTs). While RCTs are required to demonstrate effectiveness and lack of harm for pharmaceutical drugs which, by definition, are artificial compounds, they should not be required for vitamin D since it is a natural compound important for all animal life including humans. In addition, RCTs on vitamin D are difficult to conduct due to other sources of vitamin D and reduced conversion of vitamin D to 25(OH)D level at higher serum levels. It will take five years or more before large-scale RCTs testing vitamin D supplements are completed and reported. The adverse effects of oral intake of up to 4000 IU/d vitamin D3 and serum 25(OH)D levels up to 100 ng/ml are practically non-existent except for those individuals with conditions that may lead to hypercalcemia. Thus, there seems to be little reason to wait for the RCTs before implementing vitamin D policies of higher oral intake and/or moderate UVB exposure and serum 25(OH)D levels. Everyone in North America and Europe should take a supplement of 1000-4000 IU/d of vitamin D in the winter, and those with dark skin or office jobs should take vitamin D all year long. Supplementation with vitamin D is an inexpensive and very effective way to produce huge health benefits.

For further information on vitamin D, the interested reader is directed to these websites:http://www.Grassrootshealth.net, http://www.VitaminDCouncil.org, andhttp://www.VitaminDWiki.com. Dr. Grant is director of http://www.sunarc.org.

References:

1. Hollis BW, Wagner CL. Vitamin D and pregnancy: Skeletal effects, nonskeletal effects, and birth outcomes. Calcif Tissue Int. 2012 May 24. [Epub ahead of print]
2. Wagner CL, Taylor SN, Dawodu A, Johnson DD, Hollis BW. Vitamin D and its role during pregnancy in attaining optimal health of mother and fetus. Nutrients. 2012;4(3):208-30.
3. Hossein-nezhad A, Holick MF. Optimize dietary intake of vitamin D: an epigenetic perspective. Curr Opin Clin Nutr Metab Care. 2012;15(6):567-79.
4. Mostafa GA, Al-Ayadhi LY. Reduced serum concentrations of 25-hydroxy vitamin D in children with autism: relation to autoimmunity. J Neuroinflammation. 2012;9:201.
5. Whitehouse AJ, Holt BJ, Serralha M, Holt PG, Kusel MM, Hart PH. Maternal serum vitamin D levels during pregnancy and offspring neurocognitive development. Pediatrics. 2012;129(3):485-93.
6. Zittermann A, Iodice S, Pilz S, Grant WB, Bagnardi V, Gandini S. Vitamin D deficiency and mortality risk in the general population: A meta-analysis of prospective cohort studies. Am J Clin Nutr. 2012;95(1):91-100.
7. Vacek JL, Vanga SR, Good M, Lai SM, Lakkireddy D, Howard PA. Vitamin D deficiency and supplementation and relation to cardiovascular health. Am J Cardiol. 2012;109(3):359-63.
8. Pittas AG, Nelson J, Mitri J, Hillmann W, Garganta C, Nathan DM, Hu FB, Dawson-Hughes B; Diabetes Prevention Program Research Group. Plasma 25-hydroxyvitamin D and progression to diabetes in patients at risk for diabetes: an ancillary analysis in the Diabetes Prevention Program. Diabetes Care. 2012;35(3):565-73.
9. Gorham ED, Garland CF, Burgi AA, Mohr SB, Zeng K, Hofflich H, Kim JJ, Ricordi C. Lower prediagnostic serum 25-hydroxyvitamin D concentration is associated with higher risk of insulin-requiring diabetes: a nested case-control study. Diabetologia. 2012 Dec;55(12):3224-7.
10. Lang PO, Samaras N, Samaras D, Aspinall R. How important is vitamin D in preventing infections? Osteoporos Int. 2012 Nov 17. [Epub ahead of print]
11. Bergman P, Norlin AC, Hansen S, Rekha RS, Agerberth B, Bj”rkhem-Bergman L, Ekstr”m L, Lindh JD, Andersson J. Vitamin D3 supplementation in patients with frequent respiratory tract infections: a randomised and double-blind intervention study. BMJ Open. 2012;2(6). pii: e001663.
12. Tretli S, Schwartz GG, Torjesen PA, Robsahm TE. Serum levels of 25-hydroxyvitamin D and survival in Norwegian patients with cancer of breast, colon, lung, and lymphoma: a population-based study. Cancer Causes Control. 2012;23(2):363-70.
13. Marshall DT, Savage SJ, Garrett-Mayer E, Keane TE, Hollis BW, Host RL, Ambrose LH, Kindy MS, Gattoni-Celli S. Vitamin D3 supplementation at 4000 international units per day for one year results in a decrease of positive cores at repeat biopsy in subjects with low-risk prostate cancer under active surveillance. J Clin Endocrinol Metab. 2012;97(7):2315-24.
14. Bischoff-Ferrari HA, Willett WC, Orav EJ, Lips P, Meunier PJ, Lyons RA, Flicker L, Wark J, Jackson RD, Cauley JA, Meyer HE, Pfeifer M, Sanders KM, St„helin HB, Theiler R, Dawson-Hughes B. A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med. 2012;367(1):40-9.
15. Jablonski NG, Chaplin G. Human skin pigmentation, migration and disease susceptibility. Philos Trans R Soc Lond B Biol Sci. 2012;367(1590):785-92.
16. Luxwolda MF, Kuipers RS, Kema IP, Janneke Dijck-Brouwer DA, Muskiet FA. Traditionally living populations in East Africa have a mean serum 25-hydroxyvitamin D concentration of 115 nmol/l. Br J Nutr. 2012;108(9):1557-61.

About Dr William Grant

Dr. William Grant is an epidemiologist and founder of the nonprofit organization Sunlight, Nutrition and Health Research Center (SUNARC). He has written over 140 peer-reviewed articles and editorials on vitamin D and health. Dr. Grant is the Science Director of the Vitamin D Council and also serves on their Board. He holds a Ph.D. in Physics from UC Berkeley.

View all posts by Dr William Grant →

November is Vitamin D Awareness Month

"Even though you may get plenty of Vitamin D through sunlight in the Spring and Summer months, many people have a Vitamin D deficiency in Fall and Winter. While dairy provides a powerful punch of Vitamin D, sometimes it just isn’t enough." - http://www.suntancity.com/blog/vitamin-d-awareness-month

"Vitamin D deficiency is linked to a significantly higher risk of most cancers, heart disease, autoimmune diseases including the flu and costs the Canadian health care system more than $14 billion annually and is a direct cause of 37,000 premature deaths, according to a study published this year in the peer-reviewed journal Molecular Nutrition Food Research by vitamin D researcher Dr. William Grant." - https://smarttan.com/news/index.php/november-vitamin-d-awareness-month/

"It's National Vitamin D Awareness Month!
Why? Because 75% of American's are not getting the required amount for proper health and Vitamin D as a Pro-hormone plays a vital role in a number of health functions, like preventing and fighting off most forms of cancer, heart disease and is helpful for many seasonal related disorders like depression and fatigue." - http://myemail.constantcontact.com/Feb--is-Vitamin-D-awareness-month-.html?soid=1105083663754&aid=ywvP-sHYN74

D status of breastfed infants low despite supplementation

http://www.vitamindcouncil.org/d-status-of-breastfed-infants-low-despite-supplementation/

15 October 2012

Researchers in Turkey report that despite recommended daily vitamin D supplementation, the rate of vitamin D deficiency is high in 4-month-old breastfed infants.

The cross-sectional study published in the October issue of Pediatricsassessed vitamin D status of 143 exclusively breastfed infants supplemented with 400 IU of vitamin D.

Forty (28%) of the infants were vitamin D deficient (defined as ≤20 ng/mL) while 38.5% were insufficient (21-30 ng/mL). During winter months, 45.4% of infants had vitamin D levels <20 ng/mL and 10.6% of infants had levels <10 ng/mL.

The authors conclude,

“Despite supplementation with 400 IU of vitamin D daily, the rate of vitamin D deficiency was worryingly high in 4-month-old exclusively breastfed infants living in Izmir, Turkey.”

They call for additional research to clarify optimal D supplementation for the infants, especially during winter months.

Source:

Halicioglu O, et al. Vitamin D status of exclusively breastfed 4-month-old infants supplemented during different seasons. Pediatrics. October 2012.

Page last edited: 18 October 2012

Adoption halted as court told baby milk led to 'innocent' couple being accuse of abuse

Vitamin supplements in baby milk may have led an innocent couple being condemned for battering their newborn son, a top family judge has heard

Adoption halted as court told baby milk led to 'innocent' couple being accuse of abuse Photo: ALAMY

By John Bingham, Social Affairs Editor

11:58AM BST 20 Sep 2012

The boy, who cannot be named, was taken away from his parents and was poised to be adopted after multiple broken bones were put down to child abuse.

But Lord Justice McFarlane halted the process yesterday after hearing how an extraordinary combination of medical events could have led to a case of congenital rickets being overlooked.

The parents, who have fought a three-year custody battle, have been given a final chance to get their son back.

It came after lawyers had what they described as a "light bulb moment" and understood the full significance of the child's medical records.

Michael Shrimpton, for the family, who are from the north of England, told the Court of Appeal in London that there is evidence that the boy was born with a Vitamin D deficiency, inherited from his mother, leading to "soft bones" and rickets.

It suggests that the broken bones could have occurred during his difficult forceps birth, or even in the womb.

Blood tests to check for signs of vitamin deficiency, when the boy was four weeks old were normal.

But the court heard hat it is possible that it was "masked" by the formula milk given to him by his mother – which contained Vitamin D supplements.

He added that there was "striking" evidence of severe abnormalities in the functioning of the baby boy's liver, an organ instrumental in processing Vitamin D.

The judge temporarily halted the adoption process and ordered urgent medical reports.

Having a child taken away is an “exceptionally awful” ordeal, he remarked, adding that it was essential to examine whether the Vitamin D deficiency explanation for the boy's injuries was "more than an intellectual possibility".

He also noted that there was no evidence of emotional difficulties, domestic violence, alcohol or drug abuse, or any signs of dysfunction within the family, to indicate a risk of child abuse.

Mr Shrimpton said that one of the country's top endocrinologists, Professor Stephen Nussey, who has carried out pioneering work on the causes and effects of Vitamin D deficiency, will be instructed to carry out that task if he is available at short notice.

Observing that medical knowledge on the causes of infant injuries is in a state of constant movement, the barrister added: "This is an important case. It is starting to take on the appearance of a leading test case".

After hearing expert evidence in June last year, a judge at Sheffield High Court ruled that one or other of the parents must have been responsible for the baby's injuries. The same judge refused to change her mind earlier this year and freed the boy for adoption.

However, Lord Justice McFarlane observed: "Medical knowledge of how some children may have bones that are more susceptible to injury than normal children has moved on".

Emphasising the extreme urgency of the case in light of plans for the boy's imminent adoption, the judge gave the parents 28 days to obtain a report from Professor Nussey, or another expert, in support of their case.

The local authority involved in the case had informed the Appeal Court that suitable adoptive parents have already been found for the boy but no further steps in the process would be taken prior to the court ruling on the case.

The case will return to the Appeal Court once the expert medical report has been obtained.

The breastfeeding mother: Breast milk as a biomarker?

Posted on June 25, 2012 by John Cannell, MD

It just never made sense to me, 40 years ago, when my professors at UNC School of Medicine casually announced human breast milk contained no vitamin D.
“How can that be? How can that possibly be? That makes no sense,” I thought. “Was primitive man supposed to give their infants vitamin D pills that didn’t even exist?”
I have written before about biomarkers, such as:

• How high does your vitamin D level have to be to maximally suppress parathyroid hormone?
• How high does your vitamin D level have to be to maximally improve calcium absorption?
•  How high does your vitamin D level have to be to prevent abnormal bones?

The answer to these questions varies from 20 ng/ml to 40 ng/ml, depending on what study you decide to quote. But what about breast milk as a biomarker? Infants need vitamin D for strong bones and general development. Without vitamin D, the infant can develop rickets. In the 21^st century, this is treatable in a clinic. In the wild, the tribe may have left a screaming baby with soft bones at the wayside.

How high does the breastfeeding mom’s vitamin D level need to be for her infant to get natural vitamin D levels? This level is a biomarker because it gives us insight on how high vitamin D levels were for species survival. If the breastfeeding mom couldn’t supply vitamin D to the infant, our species may not have survived. Whatever vitamin D level that might be, that would be the level humans evolved to have.
Professors Wagner and Hollis and colleagues did an elegant randomized controlled trial 6 years ago that we have covered before, but it should be covered often. They simply gave two different doses of vitamin D to nursing mothers and measured the vitamin D levels of their infants and mothers. They used a small sample of breast feeding women, giving half the women a prenatal vitamin (containing 400 IU) and the other half a prenatal vitamin plus an extra 6,000 IU/day of vitamin D.
The suckling infants of the mothers given only the prenatal were also given 300 IU of vitamin D directly (it would have been unethical to deprive any of the infants of vitamin D). They noted no side effects with any dose, but the 6,000 IU/day arm of the study answered my 40-year-old question.
Wagner CL, Hulsey TC, Fanning D, Ebeling M, Hollis BW. High-dose vitamin D3 supplementation in a cohort of breastfeeding mothers and their infants: a 6-month follow-up pilot study. Breastfeed Med. 2006 Summer;1(2):59-70.
The 6,000 IU/day dose of vitamin D did three things.

1. It gave the mothers natural vitamin D levels (50 ng/ml or close to).
2. It transformed breast milk into a rich source of vitamin D.
3. It gave suckling infants natural blood levels of vitamin D (45 ng/ml).

Given this, if you are now breast-feeding and not taking vitamin D, then I hope you are giving your infant at least 400 IU of vitamin D per day as the American Academy of Pediatrics (AAP) recommends. If you want your infant to start getting their vitamin D from your breast milk, I recommend the following steps:

1. Take a loading dose of 10,000 IU/day for a month.
2. After one month on 10,000 IU/day, stop supplementing your infant with vitamin D as your breast milk should now be filled with vitamin D.
3. Take 6,000 IU/day maintenance dose thereafter, except on days you get full body sun exposure.

However — and this is important — when the breastfeeding stops, you need to start supplementing your child again, as the AAP recommends, unless the child is in the sun enough to have adequate levels, and very few are.
I’d like to reiterate, can you think of a better biomarker for how much vitamin D humans need?

• “How much vitamin D do human breast–feeding mothers have to take to transform their breast milk into an adequate source of vitamin D for their infants?”

This is a great biomarker question, one essential to the survival of our species. The answer is 50 ng/ml, which can be achieved by 6,000 IU/day for breastfeeding mothers.
Further reading:

• Taylor SN, Wagner CL, Hollis BW. Vitamin D supplementation during lactation to support infant and mother. J Am Coll Nutr. 2008 Dec;27(6):690-701. Review.

About John Cannell, MD

Dr. John Cannell is founder of the Vitamin D Council. He has written many peer-reviewed papers on vitamin D and speaks frequently across the United States on the subject. Dr. Cannell holds an M.D. and has served the medical field as a general practitioner, itinerant emergency physician, and psychiatrist.

View all posts by John Cannell, MD →

 

http://blog.vitamindcouncil.org/2012/06/25/the-breastfeeding-mother-breast-milk-as-a-biomarker/ 

Vitamin D linked to autoimmune disorders

Posted on April 12, 2012 by John Cannell, MD

There are more than 160 human autoimmune diseases, everything from type one diabetes to Lou Gehrig’s disease. They arise from an improper immune response to substances and tissues normally present in the body. In other words, the body mistakes itself as foreign and attacks its own self. The common treatment of autoimmune diseases today is to suppress the immune system in general with medications.

Recently a Chinese group led by Dr. C Mok and colleagues from Tuen Mun Hospital in Hong Kong studied 290 lupus patients and confirmed previous findings that the lower your vitamin D level, the worse your lupus. The association (remember association is not causation) was quite strong. Dr. Mok also found an amazing 96% of the lupus patients were vitamin D insufficient.

The lower your vitamin D level, the worse your lupus.

Mok CC, Birmingham DJ, Leung HW, Hebert LA, Song H, Rovin BH. Vitamin D levels in Chinese patients with systemic lupus erythematosus: relationship with disease activity, vascular risk factors and atherosclerosis Rheumatology (Oxford). 2012 Apr;51(4):644-52. Epub 2011 Jun 29.

In an accompanying editorial, Professor Luis Munoz and colleagues from Erlangen University Hospital in Germany supplied a new insight into how vitamin D is involved in autoimmune disorders, and, as far as I am aware, every one of the 160 autoimmune disorders studied so far is somehow involved with vitamin D. What could the connection be, what do 160 autoimmune diseases have in common with vitamin D?

Munoz LE, Schiller M, Zhao Y, Voll RE, Schett G, Herrmann M. Do low vitamin D levels cause problems of waste removal in patients with SLE? Rheumatology (Oxford). 2012 Apr;51(4):585-7. Epub 2011 Oct 27.

Dr. Munoz points out that vitamin D (the repair and maintenance man of the human body) has a “waste removal” function mediated via the immune system. That’s right, vitamin D is also a garbage man for the human body; it stimulates the immune system to come around and collect the debris and detritus of what is left of cells that have gone through the normal process of apoptosis, or cell death.

Evidence that a similar defect links all 160 autoimmune diseases in this garbage man process is not complete but increasingly likely. To quote Professor Munoz, “Considering these robust epidemiological data, one might believe that vitamin D deficiency plays a pivotal role in the multifaceted (cause) of autoimmunity that deserves further scientific research to pinpoint the mechanisms of action of vitamin D in the phagocytosis (eating) and clearance of dying cells.”

About John Cannell, MD

Dr. John Cannell is founder of the Vitamin D Council. He has written many peer-reviewed papers on vitamin D and speaks frequently across the United States on the subject. Dr. Cannell holds an M.D. and has served the medical field as a general practitioner, itinerant emergency physician, and psychiatrist.

View all posts by John Cannell, MD →

http://blog.vitamindcouncil.org/2012/04/12/vitamin-d-linked-to-autoimmune-disorders/

Optimal levels of vitamin D during pregnancy

March 13, 2012 -- John Cannell, MD

More than 60 years ago, based on the science of the time (science that has stagnated for 60 years), Dr. E. Orbermer of Italy wrote the following:

“Until further experimental evidence, adequate and incontrovertible, is made available, I submit that we should play for safety. In a climate like that of England every pregnant woman should be given a supplement of vitamin D in doses of not less than 10,000 IU per day in the first 7 months, and 20,000 IU (per day) during the 8th and 9th months.”

OBERMER E. Vitamin-D requirements in pregnancy. Br Med J. 1947 Dec 6;2(4535):927.

The “adequate and incontrovertible evidence” that Dr. Orbermer wanted, to a certain extent, is finally here, 60 years later. As it has to do with developing human beings, it could not be more important. The study is the highest standard of proof, a randomized controlled trial, conducted by Professor Bruce Hollis and colleagues at the Medical University of South Carolina. They took 350 pregnant women, gave 1/3 of them 600 IU/day, 1/3 of them 2,000 IU/day, and 1/3 4,000 IU/day. Then they waited to see, among many things, which group would produce infants with at least 20 ng/ml of vitamin D in their blood, the lowest limit the 2010 Food and Nutrition Board (FNB) says is needed for good fetal health.

Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL. Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res. 2011 Oct;26(10):2341-57. doi: 10.1002/jbmr.463

Surprise surprise, only the 4,000 IU/day pregnant women group even approached the minimal safety level of 20 ng/ml in their infants. Furthermore, the 2010 FNB recommendations of vitamin D in prenatal vitamins would have left 50% of the White women and 80% of the Black women with fetuses below 20 ng/ml.

However, Professor Hollis found something else, something potentially much more important. He found that the average fetus in the USA is starved for enough building blocks for his or her mother to make adequate activated vitamin D to ship to the baby; activated vitamin D that is probably used for microscopic organ development, such as in the brain.

Activated vitamin D in pregnancy is mysterious. It appears the mother makes it in her kidney (maybe some in her placenta) at levels up to 3 to 4 times normal (without maternal hypercalcemia) and ships it across to the fetus. This only happens if the mother has enough of this vital steroid hormone in her body to ship to the fetus and most mothers do not. If she can’t make it, she can’t ship it maximally, and the 38 fetal organs depending on activated vitamin D to fully develop must do the best they can do with inadequate amounts of this steroid. Of course, none of this applies to mothers who frequently sunbathe, or who take 5,000 IU/day while they are pregnant.

To quote Professor Hollis: “These findings suggest that the current vitamin D (requirements for pregnancy, currently 600 IU/day) issued in 2010 by the Food and Nutrition Board should be raised to 4,000 IU of vitamin D per day so that all women, regardless of race, can attain optimal nutritional and hormonal vitamin D status throughout pregnancy.”

The Vitamin D Council agrees and considers this an important study in support of why adults and pregnant women need at least 4,000 IU/day to elevate blood levels and improve fetal health and birth outcomes. Although there are no trials that support taking more, the Vitamin D Council believes 5,000 IU/day is equally safe and would be more effective at maintaining adequate fetal blood levels of vitamin D.

Vitamin D deficiency in UK a 'major problem'

26 January 2012
A quarter of all toddlers in the UK are lacking Vitamin D, according to research.

Vitamin D supplements are recommended for those people at risk of deficiency, including all pregnant and breastfeeding women, children under five, and the elderly, but 74 per cent of parents know nothing about them and more than half of healthcare professionals are also unaware, the BBC said.

Dr Benjamin Jacobs, consultant paediatrician at the Royal National Orthopaedic Hospital, described the issue as a "major problem".

He told BBC Breakfast: "We see about one case of rickets a month in our hospital, but that's the very severe end of the disease.



"There are many other children who have less severe problems - muscle weakness, delay in walking, bone pains - and research indicates that in many parts of the country the majority of children have a low level of Vitamin D."



He explained that it was discovered that Vitamin D prevents rickets about 100 years ago when most children in London suffered from the disease, and it was later eradicated.

But then, in the 1950s, there was concern that children were getting too much Vitamin D in food supplements and cod liver oil and supplements were stopped. This was unlike in other Western countries where they continued, he said.

Dr Jacobs said: "We thought they were unnecessary, possibly harmful, and that was a major mistake."

He said parents are largely unaware of the risk of the condition, while health professionals are often taught that rickets is a disease of the past.

"It's really only over the past 10 years or so that I've noticed children with Vitamin D deficiency. and still I would say today, the majority of doctors, health visitors, midwives, nurses, are not aware enough of the problem," he said.

Asked about how vulnerable people can be given more Vitamin D, Dr Jacobs said current guidelines suggest taking drops or tablets, but experts are also looking into food supplementation.

He said it would not be harmful if people ended up with too much Vitamin D in their diet.

Current guidelines suggest that children and pregnant women should have 400 units a day, but he described this as a "conservative" level compared to the US, where he said a study suggested pregnant women should have 4,000 units.

"In my view, it is extremely safe," he added.

Chief medical officer Professor Dame Sally Davies said the Government would be reviewing the issue.

She said: "We know a significant proportion of people in the UK probably have inadequate levels of Vitamin D in their blood.

"People at risk of Vitamin D deficiency, including pregnant women and children under five, are already advised to take daily supplements.

"Our experts are clear - low levels of Vitamin D can increase the risk of poor bone health, including rickets in young children.

"Many health professionals such as midwives, GPs and nurses give advice on supplements, and it is crucial they continue to offer this advice as part of routine consultations and ensure disadvantaged families have access to free Vitamin supplements through our Healthy Start scheme.

"It is important to raise awareness of this issue, and I will be contacting health professionals on the need to prescribe and recommend Vitamin D supplements to at-risk groups.

"The Department of Health has also asked the Scientific Advisory Committee on Nutrition to review the important issue of current dietary recommendations on Vitamin D."

Last month a young couple walked free from court after being cleared of killing their four-month-old son after it was found he had been suffering from rickets.

Rohan Wray and Chana Al-Alas of Islington, north London, fell under suspicion when baby Jayden died suddenly two years ago.

But, following a six-week trial at the Old Bailey, charges of murder and causing or allowing his death were dropped.

Page last edited: 01 March 2012