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Old 07-13-2008, 07:52 PM   #1 (permalink)
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Doctors address vitamin D deficiencies

Doctors address vitamin D deficiencies

By JOHN FAUBER
jfauber@journalsentinel.com

Posted: July 13, 2008

It’s just before noon, and the emergency room already is filling with patients.

Photo/Jack Orton
John Whitcomb, while treating Alice Carter at Aurora Sinai Medical Center in Milwaukee, takes the time to tell her about the need for more vitamin D.


John Whitcomb, a lanky, high-octane physician, scurries from exam room to exam room, keeping pace with an onslaught of people coming in with chest pain, ankle injuries, seizures and stomachaches. The ER at Aurora Sinai Medical Center in Milwaukee isn't the most likely place to get a friendly lecture about vitamin D.
But Whitcomb, one of a small but growing number of physicians who think deficiency of the sunshine vitamin is its own public health emergency, preaches to anyone who will listen.
A growing body of research suggests that inadequate vitamin D can substantially increase the risk of a variety of diseases, including several cancers, heart disease, high blood pressure, diabetes, depression and multiple sclerosis as well as the risk of falling and infections.
In northern regions like Wisconsin, where vitamin D levels are low, the concern is even more pronounced because of a lack of ultraviolet radiation during much of the year.
Now pockets of physicians here and around the country are making vitamin D a high priority.

Spreading the word

Steve Trapp, 38, was on a bus from Chicago to Seattle last month when he began vomiting at the Milwaukee bus station. He was taken to the ER at Aurora Sinai. Whitcomb diagnosed the problem as a bout of stomach flu and dispensed nausea medicine - and an ample dose of vitamin D advice.
As Trapp lay in an exam room, Whitcomb rattled off a few recent research findings on how vitamin D can reduce the risk of various diseases. He told the couple how there really is no food source that can provide ample levels of the vitamin.
He said the sun's angle drops in winter, and with that shift, vitamin D levels in the blood decrease from an average of about 40 nanograms per milliliter to less than 20 ng/ml.
"When the level drops below 32, many of the body's functions don't work right," he said.
Only supplements or ultraviolet light can prevent that from happening.
Over the past two years, Whitcomb estimates that he has talked to more than 1,000 patients about vitamin D in the ER or other urgent care facilities in the area. He's written about vitamin D in newsletters and given talks to other doctors.
He's even tested the blood of ER patients to find out their vitamin D levels. Invariably, the levels are extremely low.
While there is not unanimous agreement on what is the optimal vitamin D blood level, many researchers say it should be at least 30 ng/ml and preferably between 40 and 60.

No large clinical trials

Exposure to intense sunlight was mostly a year-round occurrence for our prehistoric ancestors who, for thousands of years, existed naked near the equator.
It has been only in relatively recent human evolutionary history that people moved north, began wearing clothing and spent more time indoors, resulting in vitamin D deficiencies.
The vitamin actually is a hormone that plays a role in the regulation of more than 100 genes, many of which are involved in preventing diseases.
However, while that theory sounds attractive to vitamin D advocates, much of the research pointing to the vitamin's disease-preventing ability is observational in nature. While most of those studies show a benefit, some do not.
Nevertheless, observational studies pointing to potential health benefits from the vitamin continue to pile up.
A study released late last month found higher rates of death from all causes and from cardiovascular disease among a group of 3,258 heart patients with low levels of vitamin D in their blood, compared with heart patients with higher levels of vitamin D.
Also in June, a study involving 18,225 men found that those with vitamin D levels below 15 ng/ml were 2.4 times more likely to have a heart attack than those with levels above 30 ng/ml.
Last year, an analysis involving 1,760 women found a 50% reduction in breast cancer risk in those whose vitamin D levels were more than 52 ng/ml, compared with levels of less than 13.
After reading a variety of vitamin D studies, Tara Rakowski, an east side family practice physician with Columbia St. Mary's, began testing for the vitamin in her patients. In more than 60% of the approximately 500 patients, vitamin D levels were less than 20 ng/ml, she said. Now, "there isn't a patient I don't check it on," she said.
Typically she will put patients with low vitamin D levels on a prescription regimen of 50,000 international units of vitamin D a week. After that, they usually take 2,000 IU a day in the form of vitamin D3, which is inexpensive. That's the dose many vitamin D proponents now are recommending, although it is considerably more than the current recommended intake, which ranges from 200 IU in children to 600 IU in the elderly.
Rakowski said her patients often feel better after boosting their vitamin D levels.
Jaishree Hariharan, an internal medicine physician who practices at Froedtert Hospital, said she had checked vitamin D levels in about 200 patients in the past year. Most have levels below 20 ng/ml, she said.
"The big misnomer that most physicians are worried about is vitamin D toxicity," said Hariharan, an associate professor of medicine at the Medical College of Wisconsin. However, with doses of 2,000 IU a day, "there is no downside," she said.

Upping her dose

Alice Carter, a 63-year-old from Milwaukee, is lying on a bed with chest pain in the ER at Sinai Medical Center.
After Whitcomb determines the Milwaukee woman is having a bout of angina, he begins telling her about vitamin D.
He seems pleasantly surprised when she tells him that she started taking 1,000 IU a day about a year ago, but he says she should up the dose to 2,000.
"Your skin pigment protects you from sunburn, but it also means you need to get three to four times as much sunlight to make the same amount of vitamin D," he tells Carter, who is African-American.
He tells her that many African-Americans he has tested have vitamin D levels of less than 10, but blacks living near the equator in Africa have levels near 60, he says.
"So are you saying I need to move down South?" she jokes.
Whitcomb says that won't be necessary if she increases her summertime dose to 2,000 IU and her wintertime dose to 4,000.
"I'll take the 2,000," she says.

SOURCE LINK: http://www.jsonline.com/story/index.aspx?id=771545

This is also from that page:

Getting Enough Vitamin D

Getting 2,000 IU of vitamin D from the diet alone is impractical for most people.
The only food source that contains high levels is cod liver oil, which contains about 1,400 IU in a tablespoon.
A cup of vitamin D-fortified milk contains about 100 IU.
Researchers say the only other ways to get high levels is through supplements and exposure to ultraviolet light.
Some research suggests that five to 30 minutes of sun exposure twice a week between 10 a.m. and 3 p.m. on the face, arms, legs and back without sunscreen is enough to produce adequate vitamin D levels. However, too much sun exposure increases the risk of skin cancer.
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