Fractures and vitamin D

27. April 2010 William Davis (25)
This is a bit off topic, but it's such an interesting observation that I'd like to pass it on.

Over the past several years, there have been inevitable bone fractures: People slip on ice, for instance, and fracture a wrist or elbow. Or miss a step and fracture a foot, fall off a ladder and fracture a leg.

People will come to my office and tell me that their orthopedist commented that they healed faster than usual, often faster than anyone else they've seen before. My son was told this after he shattered his hand getting slammed against the boards in hockey; his orthopedist took the screws and cast off much sooner than usual since he judged that healing had occured early. (My son was taking 8000 units vitamin D in gelcap form; I also had him take 20,000 units for several days early after his injury to be absolutely sure he had sufficient levels.)

My suspicion is that people taking vitamin D sufficient to enjoy desirable blood levels (I aim for a 25-hydroxy vitamin D level of 60-70 ng/ml) heal fractures much faster, abbreviating healing time (crudely estimated) by at least 30%.

For any interested orthopedist, it would be an easy clinical study: Enroll people with traumatic fractures, randomize to vitamin D at, say, 10,000 units per day vs. placebo, watch who heals faster gauged by, for instance, x-ray. My prediction: Vitamin D will win hands down with faster healing and perhaps more assured fusion of the fracture site.
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Comments (25) -

  • River Rat

    4/26/2010 11:18:16 PM |

    Just anecdotal, but I had an experience that confirms your theory.  In the middle of a 21-day trip down the Colorado through Grand Canyon, I fell and fractured my arm.  I decided just to splint it up and continue the trip, since the pain wasn't too bad.

    By the time I got to a clinic in Flagstaff, 10 days later, the doctor said everything had healed so well I didn't even need a cast.  

    Needless to say, there is lots of free Vitamin D in the Grand Canyon in summer!  We were in the sun all day long.  Maybe it made the difference.

  • ithink

    4/27/2010 12:18:12 AM |

    probably also has to do with the fact people are calcium deficient without vitamin d.

  • DrStrange

    4/27/2010 12:51:24 AM |

    Isn't there evidence that the blood level vs benefit curve reverse itself ("U" shape) above around 60 ng/ml?  Maybe just under or at that safer???

  • mongander

    4/27/2010 2:02:11 AM |

    Last fall I was happy with my blood level of vit D, 79 ng/ml, so I reduced my daily dose from 10,000 iu to 5,000 iu.   I just got my spring test result and my level dropped 23 points to 56 ng/ml.  I'm gonna go back to 10,000 iu, except maybe during the summer when I get a lot of sun.

  • TedHutchinson

    4/27/2010 12:23:13 PM |

    How to Optimize Vitamin D Supplementation to Prevent Cancer, Based on Cellular Adaptation and Hydroxylase Enzymology" You can read Reinhold Vieth's justification for keeping 25(OH)D both high and STABLE here.
    In order to regulate any system there has to be a means of both increasing and decreasing responses.
    Where the upregulation and down regulation is performed by different substances both of which are derived from Vitamin D, it follows these have to be kept tightly controlled and always in balance.
    Sudden rise in 25(OH)D causes a period of imbalance between those forces, during which too much immunosuppression may occur.
    The further north people live the more extreme differences between Summer/winter status. It isn't surprising those flying to the tropics for short midwinter sun breaks end up catching something from recycled germs during the flight home.
    Making sure your Vitamin D needs are met daily throughout the year evens out the percentage change in levels as naturally more vitamin D3 is made in low 25(OH)D skin than when 25(OH)D is high.

    Correcting vitamin D deficiency BEFORE a winter sun break results in a lower increase in 25(OH)D.
    Less change in status = shorter period of imbalance.

    I don't have to remind readers here Ergocalciferol speeds up the catabolism of vitamin D Cholecalciferol has a longer half life. Using Vitamin D2 therefore promotes greater/faster swings in status and should be avoided.

    Using Vitamin D3 supplements daily at amounts no greater than UVB exposed skin would naturally produce, most nearly replicates the changes in status human DNA would have evolved with.

    Apologies to Dr Vieth for assuming the copy of the paper linked to above was non-copyright and putting it online.  I think it's important the public have access to the full text rather than just my garbled version of this important paper.

  • Ned Kock

    4/27/2010 1:17:02 PM |

    Thanks Dr. Davis for the post sharing you personal experiences.

    DrStrange:

    The relationship seems to follow a U-curve pattern, with very high levels being associated with hypervitaminosis D problems.

    The levels mentioned by Dr. Davis seem well below the ones that can lead to toxicity. For example, a farmer in Puerto Rico had a level of 225 nmol/L (90 ng/mL), and had no signs of toxicity:

    http://healthcorrelator.blogspot.com/2010/02/vitamin-d-levels-sunlight-age-and.html

    From the post above, toxic doses seem to start around 50,000 IU per day. That's way more than the 10,000 IU or so that we get from sun exposure.

    My only point of disagreement with Dr. Davis is about our ability to produce vitamin D from sunlight after age 40. There is research (post above too) showing that the elderly can produce as much as 80 percent vitamin D from sunlight as do 20 or 30 year olds.

  • homertobias

    4/27/2010 3:21:19 PM |

    Hi Dr.Davis.
    I just wanted you to know that THIS PRACTIONER is running her own open label trial on 5-10 people with lp(a).  I will let you know the outcome.
    I just read your trial on 45 CAC high scorers that you published in Am J of Theraputics last year.  I hear that the registration process to publish is a horrific process. I am glad you persisted,  I really wanted your raw data but...

  • Tom

    4/27/2010 6:58:50 PM |

    I hope I'm not diverting from the topic here....I'm confused about the Vit D-Calcium interaction.

    I believe I understand correctly that high Vit D levels allow the body to more effectively process calcium.

    I don't understand how calcium requirements change with increased Vit D levels.  I have a blood level of 72 (D3) and 3 (D2).  But I haven't paid attention to my calcium intake.

    Can anyone clarify the relationship between Vid D and calcium please?

    Thank you in advance.

  • DrStrange

    4/27/2010 7:00:05 PM |

    "The relationship seems to follow a U-curve pattern, with very high levels being associated with hypervitaminosis D problems."

    Not hypervitaminosis D but rather reversal of D's benefits.  I had read that above 60 ng/ml the risk of prostate cancer increased again.  Just now searching for the study found on D council site, a recent article showing the likelihood that this outcome was because the research subjects had all gotten their higher D levels from Cod liver oil and the vitiman A in that is what reversed the benefits of D, not the high levels of D!  So seems I could well have been misinformed about that.

    http://www.vitamindcouncil.org/newsletter/vitamin-d-vitamin-a-and-cancer.shtml

  • sonny

    4/27/2010 11:32:00 PM |

    Just threw out all multivitamins in the house after hearing about vitamin A interfering with vitamin D absorption.

  • TedHutchinson

    4/28/2010 8:27:12 AM |

    @ Dr Strange
    Tuohimaa's team claiming they have found a U shaped curve for Vitamin D is based in Tampere, Finland latitude 61N
    People at that latitude with high 25(OH)D levels have experienced a greater change in level from summer to winter or if they choose to take a winter sun break will experience further re-balancing of the immune system. Vieth argues it is the length and number of periods of imbalance that drive the effects Tuohimaa reports.

    Now we have greater availability of effective strength D3 it will be easier for people at that latitude to attain and maintain the levels that enabled the Inuit to survive long winters with over 6000iu daily vitamin D3 provided from traditional diet.

    @ Tom
    Video of Heaney explaining the calcium/vitamin D story

    The Vitamin D requirement in health and disease Heaney similar information in PDF form but in greater detail.
    Bear in mind when considering Vitamin D and Calcium absorption that other co-factors work in synergy with Vitamin D.
    Magnesium is required to power the  production of the active hormone Calcitriol that lowers PTH and magnesium also counterbalances the role of calcium as magnesium is a natural calcium channel blocker.
    Each Vitamin D Receptor requires zinc.
    Also Vitamin K2 mk4 is critical for healthy bone density transporting calcium from bloodstream to bone.

  • Kent

    4/28/2010 8:13:45 PM |

    There has been at least one study done. Here's one with guinea pigs.
    http://www.springerlink.com/content/w734p41874205516/

    This is another area where common sence and experience shouldn't really require a study to initiate this course of action. Example; I saw the other day there was a "study" done on children that proved that what they saw on TV affected their actions. I'm sure many parents are glad that study "finally" came through!

  • Jason

    4/28/2010 9:40:56 PM |

    New study on grains:

    http://www.lef.org/news/LefDailyNews.htm?NewsID=9615&Section=Nutrition

    "Published research shows eating two to four serves of wholegrain foods a day can reduce the risk of heart disease by as much as 40 percent - equal to the effect of cholesterol lowering drugs,"

  • Tom

    4/29/2010 1:03:42 PM |

    To TED,

    Thank you Ted for the information.  The Heaney video was very interesting and worthwhile.  It's interesting that he says optimal D3 for calcium absorbtion is between 80 and 120 nmol.  I'm at 70 nmol and thought I was fine!
    The video is well worth watching.

    nevertheless, I'm still trying to understand how much calcium I should be taking, assuming I get my D3 to 80 or so.

    Your remarks about Magnesium, etc. are helpful.  Thank you.  But again, I struggle with how much?  

    Tom

  • Daniel

    4/30/2010 4:23:49 PM |

    Ted,
    Another explanation, this one from Cannell, for the U curve found in Scandinavia is cod liver oil.  

    People with the highest vit D levels may be consuming enormous amounts of cod liver oil and, thus, vitamin A.

    Excess retinol may thwart the action of vit D by competing for certain nuclear receptors.

  • P90X Results

    5/3/2010 9:57:44 AM |

    This is very useful information of Obesity. You can find more information about how to prevent heart diseases. I am very excited about your post, it's really amazing.

  • Tom

    5/3/2010 10:45:10 PM |

    To Ted,

    Thank you once more for this information.

    I just read that calcium has been implicated in Prostrate cancer.  have you heard anything about this?

  • Anonymous

    7/28/2010 5:01:59 PM |

    Do you know if anything helps for soft tissue injuries? I am still not fully recovered from a foot injury 5 months after the acute phase. The orthopedist expected it to take 4 weeks to heal and I'm a little concerned about how long it will take.

  • Troy @ shipping quote

    12/31/2010 5:44:10 AM |

    The above blog post is quite informative. Having good information related to bones and its requirements. I was not knowing that Vit D is so important for our bones. But good to know about that. Want to ask what are the natural resources of Vit D in our daily diet?

  • CatinaAgilar6368@hotmail.com

    1/1/2011 12:48:29 PM |

    Quite an informative blog post. I know that inadequate amount of vitamin D in diet can lead to osteoporosis, which is a brittle bone disease. But are there any side effects of excessive intake of vitamin D.

  • Nevil - same day courier

    3/22/2011 12:13:49 PM |

    Great post William, my friend is really having some bone problem, so this information will be quite useful for him. Looking forward for more post on the same topic.

  • Hal

    5/7/2011 4:11:01 PM |

    I know someone who was in a car accident that resulted in very serious fractures of one arm and wrist.  He is in his late 60's and his injuries were not healing.  

    I came to know this person about 6 months after the accident.   He was taking about 2 grams of  calcium per day thinking that this would help his bones, perhaps because the doctor told him to talk more calcium, but no supplemental  Vitamin D.   I told him that the should be taking at least 5000UI D3  per day pointing out that Walmart has 5000UI gel caps for cheap ($5 per 100 at that time) and that he was likely taking too much calcium.  He started taking more D3 although I am not sure how much since I didn't want to be pushy.  

    It has been about 9 months now since he started taking more D3 and his injuries have healed and he has had surgery to remove most of the plates and screws that had been put in place.    Was D3 the reason for this?    I don't know but I am sure that it didn't hurt either.

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Hospitals: Then and Now

Hospitals: Then and Now

2. September 2006 William Davis (0)
It's 1920. The hospital in your city is a facility run by nuns or the church. It's a place for the very ill, often without hope of meaningful treatment, but nonetheless a place where surgeries take place, babies are born, the injured and chronically ill can find care. No one has health insurance and there's no Medicare. Everyone pays what they can. The hospital is accustomed to doling out plenty of care without compensation. For that reason, they welcome donations and sometimes will build new additions or other facilities in honor of a major donor.

Volunteeers are common, since the wards are understaffed and generally suffering from a shortage of trained nurses and personnel associated with the church. Drugs, such as they are, are often prepared from basic ingredients in the hospital pharmacy. Product representatives hawking medicines and devices are virtually unheard of.

Though their therapeutic tools are limited, the physicians are a proud group, dedicating their careers to healing. The majority of the medical staff volunteer large portions of their time to care for the poor who come to the hospital with very advanced stages of disease: metastatic tumors, advanced heart failure, debilitating strokes, overwhelming septicemia, etc.

Hospitals are usually governed by a board of clergy and physicians who make decisions on how to apply their limited resources and continually seek charitable donations.


Fast forward to present day: Hospitals are high-tech, professional facilities with lots of skilled people, complicated equipment,and capable of complex procedures. While they still house people with advanced illnesses, the floors are also filled with people with much earlier phases of disease. In general, they do a good job, with quality issues scrutinized by a number of official agencies to police practices, incidence of hospital-related infections, medication errors, care protocols, etc.

The hospital of 2006 is a more more effective place than the hospital of 1920. But its aims and operations are different, also. Though some churches are still involved in hospitals, more and more are owned by publicly-traded companies that answer to shareholders--shareholders who want share value to increase. Though donations are still sought, much of the revenues are obtained by concentrating on profitable, large-ticket procedures. More procedures are often generated by advertising.

Because they operate to generate profits, several hospitals in a single city or region compete with one another. The 21st century has therefore witnessed the phenomenon of hospital-owned physicians: more and more practicing physicians are employees of their hospital. That way, the physician brings all his patients and procedures to his hospital, not to a competitor. The top of the funnel is the primary care physician, who tends to see all disease when it first occurs. The primary care physician then sends the patient to the specialist, who is obliged (by contract) to perform his/her procedure in the hsopital paying their salary.




Representatives from companies manufacturing and selling expensive hospital equipment and drugs are everywhere, falling over themselves to gain attention of the physicians using their equipment and the hospital buyers who make purchasing decisions. Millions of dollars can be transacted with just one sale.

The number of volunteers has dwindled. The poor and uninsured are commonly diverted elsewhere, often to a government-funded, and often second-rate, institution. Hospitals measure success by comparing annual revenues and numbers of major procedures.

The hospital of 2006 is a vastly different place than 1920. If you're expecting charitable treatment, compassion, and selfless care, you're in the wrong century. In 2006, the hospital is a business. You don't expect charitable treatment at Wal-Mart or from your car dealer. Don't expect it from your hospital. They are businesses and you are a customer. Recognize this fact, lose the nostalgia for the hospitals of yesterday, and a lot more will become clear to you.
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Real men don't eat carbs

Real men don't eat carbs

27. April 2011 William Davis (0)
Real men don't eat carbs. At least they don't eat them without eventually paying the price.

How do carbohydrates, especially those contained in "healthy whole grains," impair maleness? Several ways:

--Consume carbohydrates, especially the exceptional glucose-increasing amylopectin A from wheat, and visceral fat grows. Visceral fat increases estrogen levels; estrogen, in effect, opposes the masculinizing effects of testosterone. Overweight males typically have low testosterone and high estrogen, a cause for depression, emotionality, weight gain, and low libido.

--Sugar-provoking carbohydrates like wheat cause visceral fat to accumulate which, in turn, triggers prolactin to be released. Increased prolactin in a male causes growth of breasts: "man boobs,""man cans," "moobs," etc. This is why male breast reduction surgery is booming at double-digit growth rates. In cities like LA, you can see billboards advertising male breast reduction surgery.

--Carbohydrates increase visceral fat that sets the stage for postprandial abnormalities, i.e., markedly increased and persistent lipoproteins, like chylomicron remnants and VLDL particles, that impair endothelial function literally within minutes to hours of ingestion. Impaired endothelial function underlies erectile dysfunction. This is why Internet spammers so enthusiastically send you offers for discounted Viagra.

--Carbohydrates increase blood sugar which provokes the process of glycation, glucose modification of proteins, that also contributes to endothelial dysfunction followed by erectile dysfunction.

Real men therefore avoid carbs.
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Money, money, money, money

Money, money, money, money

3. October 2007 William Davis (3)
I've been asked the question numerous times:

Why aren't heart scans more popular?

First, let me qualify by saying that heart scan have indeed grown in popularity over the past decade. I think the real question is:

Given the enormous usefulness of CT heart scanning to detect hidden, asymptomatic coronary atherosclerotic plaque, why haven't they more readily been incorporated into conventional medical practice?

That's easy: There's no money in it.


Say, for instance, your doctor orders a heart scan and somehow receives a $1000 for the test. Scan centers would be scanning 100 people a day, falling over themselves to do scans.

This would be similar to a heart catheterization. Order a catheterization, do 30 minutes of work, and get $1000. Or, order a nuclear stress test. Depending on how its done and where, $1800-4000 is paid by the insurer.

Order a CT heart scan and how much is paid to the doctor? Usually nothing. At most, a nominal fee might be paid if the doctor reads the scan.

With heart scans, there simply is no big payoff.

We learned the implications of this situation 10 years ago when I was trying to help my friend, Steve Burlingame, the owner of Milwaukee Heart Scan. (I am NOT and NEVER WAS an owner.) Steve was trying to let everybody know about this great new $2 million dollar heart scan device in the Milwaukee area.

The first few years were tough for Steve: Carrying the substantial expense of this device while doctors essentially gave the technology the cold shoulder. It simply did not fit into the financial equation. Why change the way things were, particularly when there was virtually no financial reason to do so? To counter this, Milwaukee Heart Scan followed the model many other scan centers have followed and marketed directly to the public.

I see this as yet another example of why people need to take control of health care away from doctors and hospitals, the current controllers of the system who are providing a disservice to the public they are supposed to be serving. These institutions, for the most part, serve their self-serving financial interests, not your health interests. It's the same equation that drives food manufacturers to make more and more processed carbohydrate foods that they sell for substantial markups, not green peppers and cucumbers that make little money.

I regard heart scans as among the greatest self-empowering tools in health ever conceived. It was that way in 1997; it remains that way in 2007.
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  • Anonymous

    10/3/2007 5:41:00 PM |

    I personally get the word out on how heart scans are superior to regular cholesterol testing in predicting future heart health to family and friends.  Honestly many times I'm greeted with skepticism, "if a CT scan is so great, why hasn't my doctor recommended one?"  When that happens, your blogs are a wonderful tool to me in convincing them of there importance.    

    Many place doctors on a very high pedestal, too high I believe, and so in this case I find it bad that doctors do not make money on CT heart scans.  I do not have anything against people making money in an honest manor and if it takes some cash to change a few more healthy care providers’ ways on heart scanning, I'm in favor of it.

  • JoeEO

    10/3/2007 7:41:00 PM |

    Dr Davis,
    You are creating an "Army of Davids"! The phrase is from a book written by Glenn Reynolds (aka Instapundit.com ). The premise of the book is that "a society that's rich and free will have citizens who-entirely on their own-develop a wide range of skills."

    That is what we are doing here (and at Trackyourplaque.com) we are learning to manage and diagnose and treat our various lipid profiles and tracking our levels of coronary artery disease (plaque).

    I think I mentioned this in a post on typ's member forum, but I still can't understand why every person in the US who is taking a statin is not also taking niacin. If the your sites didn't exist I doubt I would have found out about the HATs study until I had a coronary event (if then)

    Now I am empowered (it is a little scary!) and have the ability to find out detailed information about my condition and the ways I can address that condition thanks to you Dr Davis!


    We live in amazing times...


    Peace

    Joe E O
    P.S. Here the whole title from Amazon.com:
    An Army of Davids: How Markets and Technology Empower Ordinary People to Beat Big Media, Big Government, and Other Goliaths (Hardcover)
    by Glenn Reynolds (Author)

  • Dr. Davis

    10/3/2007 8:30:00 PM |

    Thanks, Joe. It is an exciting time for immense change.

    Would you recommend Reynolds' book?

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Take a walking vacation

Take a walking vacation

20. May 2006 William Davis (1)
If you're planning a vacation, why not consider a walking vacation?

The concept is really taking off. All you need is a pair of comfortable shoes and an interesting locale. More and more services are popping up to help you plan fun and interesting destinations and itineraries. One such catalog can be found at http://walking.about.com/od/tours/a/walkingvacation_3.htm

Lengthier walks may require some advance planning and toting some supplies. Don't forget the water!

From a health viewpoint, a walking vacation sure beats the heck out of a cruise that packs on 12 pounds of extra weight from the 24-hour a day buffet. If you're in the midst of a weight loss effort, several hours of walking through interesting locales and scenery can make it effortless.

There's loads of neat places to visit from a walker's perspective. One interesting website is www.waterfallwalks.com that lists trails that provide spectacular views of waterfalls.

Another variation on this theme is biking vacations. My wife and I are trying to set the time aside for a biking tour of wineries in the French countryside. That's our kind of multi-tasking!
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  • Physical Therapy Supplies

    6/14/2011 5:47:58 AM |

    A walking vacation. I loved it! I ask people to stay in touch and share their story with me when they reach their final destination. Plan your walk spontaneously or consult a tour company who will book hotels ahead of time, arm you with a map, and lighten your load by transporting your bags to the next destination.

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