Hospitals are a hell of a place to get sick

I answered a page from a hospital nurse recently one evening while having dinner with the family.

RN: "This is Lonnie. I'm a nurse at _____ Hospital. I've got one of your patients here, Mrs. Carole Simpson. She's here for a knee replacement with Dr. Johnson. She says she's taking 12,000 units of vitamin D every day. That can't be right! So I'm calling to verify."

WD: "That's right. We gauge patients' vitamin D needs by blood levels of vitamin D. Carole has had perfect levels of vitamin D on that dose."

RN: "The pharmacist says he can replace it with a 50,000 unit tablet."

WD: "Well, go ahead while Carole's in the hospital. I'll just put her back on the real stuff when she leaves."

RN: "But the pharmacist says this is better and she won't have to take so many capsules. She takes six 2,000 unit capsules a day."

WD: "The 50,000 units you and the pharmacist are talking about is vitamin D2, or ergocalciferol, a non-human form. Carole is taking vitamin D3, or cholecalciferol, the human form. The last time I checked, Carole was human."

RN: (Long pause.) Can we just give her the 50,000 unit tablet?

WD: "Yes, you can. But you actually don't need to. In fact, it probably won't hurt anything to just hold the vitamin D altogether for the 3 days she's in the hospital, since the half-life of vitamin D is about 8 weeks. Her blood level will barely change by just holding it for 3 days, then resuming when she's discharged."

RN: (Another long pause.) Uh, okay. Can we just give her the 50,000 units?"

WD: "Yes, you can. No harm will be done. It's simply a less effective form. To be honest, once Carole leaves the hospital, I will just put her back on the vitamin D that she was taking."

RN: "Dr. Johnson was worried that it might make her bleed during surgery. Shouldn't we just stop it?"

WD: "No. Vitamin D has no effect on blood coagulation. So there's no concern about perioperative bleeding."

RN: "The pharmacist said the 50,000 unit tablet was better, also, because it's the prescription form, not an over-the-counter form."

WD: "I can only tell you that Carole has had perfect blood levels on the over-the-counter preparation she was taking. It works just fine."

RN: "Okay. I guess we''ll just give her the 50,000 unit tablet."


From the alarm it raises trying to administer nutritional supplements in a hospital, you'd think that Osama Bin Laden had been spotted on the premises.

I laugh about this every time it happens: A patient gets hospitalized for whatever reason and the hospital staff see the supplement list with vitamin D, fish oil at high doses, iodine, etc. and they panic. They tell the patient about bleeding, cancer, and death, issue stern warnings about how unreliable and dangerous nutritional supplements can be.

My view is the exact opposite: Nutritional supplements are a wonderful, incredibly varied, and effective array of substances that, when used properly, can provide all manner of benefits. While there are selected instances in which nutritional supplements do, indeed, have interactions with treatments provided in hospitals (e.g., Valerian root and general anesthesia), the vast majority of supplements have none.

Comments (19) -

  • Jessica

    10/29/2009 12:25:04 AM |

    We use an EMR and recently on the online forum for the EMR, an MD posted a question about an error message he received when he transmitted an rx electronically to the pharmacy.

    He said he had written for 50,000 IU of Vitamin D (weekly x 8 weeks) and during the transmission, the comma was dropped so the pharmacist received a RX that only read "50 IU."

    The MD posted the issue b/c he wanted to know if others were having the same problem with RXs that contained a comma.

    I replied to the post and answered his technical question, but was disappointed in his choice for intervention. I didn't reply with any info about D2 versus D3 (who am I to educate a physician about medicine?) but in hindsight, I probably should have. Who knows how many other people will receive suboptimal Vitamin D treatment.

    P.S. If you need a good laugh, grab a copy of the latest AFP magazine and read the D article. Their suggested intervention for D deficiency....50,000 IU D2 for 8 weeks. Yauzers.

    I might keep the article for historical significance. My hope is that in just a few short years, we'll look back on such non-sense and be proud of how far we've come with treating D.

    P.P.S. I'm going to the Vitamin D conf in Toronto on Tuesday! I cannot wait!!

  • Anonymous

    10/29/2009 2:40:01 AM |

    The way the nurse kept asking if it was okay to have the patient take the D2 tablets, I couldn't help wonder if the pharmacist was getting a kick back for those tablets. What also bugged me was how she didn't want to "hear" or honor what you had to say even though you are the patient's doctor. Not good.

  • Dots

    10/29/2009 5:00:34 AM |

    I'd LOL if it weren't so sad.

    BTW, I've gotten two doctor neighbors and family on vitamin D and probiotics.  One is egotistical, the other grateful.  Thanks for all you do.

  • Mark K. Sprengel

    10/29/2009 5:25:16 AM |

    So they needlessly increased her costs? Great :/

  • moblogs

    10/29/2009 10:31:29 AM |

    You know, I don't bother telling doctors exactly how much D3 I'm taking. I just get them to check my blood levels and they see no problems with the results. But they would probably balk at the fact I take 10k per day.

  • Helena

    10/29/2009 1:38:59 PM |

    I am a bit disgusted about this whole thing. This shows ones again how stupid the whole industry is… I was just recently at my doctor to take a few tests after some horrible years on the birth control pill Yasmin (it had basically taken me 7 years to put two and two together because no doctor would believe my symptoms well at least not connect them to the birth control). He asked me why I was taking all these vitamins and supplements – Preventive maintenance, was my answer. No comment back except for a smirk. Well yesterday they called me to tell me that everything was ok, but didn’t understand why I wanted to see my own lab results… the woman I was speaking to almost questioned my motive for wanting to see it. What the heck is wrong here… ???

  • Anonymous

    10/29/2009 1:54:06 PM |

    Nutrient Biomarkers Analytical Methodology: Vitamin D Workshop
    The National Institutes of Health (NIH) Office of Dietary Supplements (ODS) is sponsoring the Nutrient Biomarkers Analytical Methodology: Vitamin D Workshop on Wednesday, December 16, 2009 at the Bethesda North Marriott Hotel & Conference Center, Bethesda, Maryland.


    Workshop Summary
    Vitamin D is a fat-soluble vitamin that is naturally present in very few foods, added to others, and available as a dietary supplement. It is also produced endogenously when ultraviolet rays from sunlight strike the skin and trigger vitamin D synthesis. Vitamin D obtained from sun exposure, food, and supplements is biologically inert and must undergo two hydroxylations in the body for activation. The first occurs in the liver and converts vitamin D to 25-hydroxyvitamin D [25(OH)D], also known as calcidiol. The second occurs primarily in the kidney and forms the physiologically active 1,25-dihydroxyvitamin D [1,25(OH)2D], also known as calcitriol.

    Serum concentration of 25(OH)D is the best indicator of exposure to vitamin D from all sources. It reflects vitamin D produced cutaneously and that obtained from food and supplements. There is considerable discussion of the serum concentrations of 25(OH)D associated with deficiency (e.g., rickets), adequacy for bone health, and optimal overall health. In fact, different assay methods are used to assess 25(OH)D. The methods themselves vary and there are considerable differences among laboratory results even when they use the same method.

    Given the uncertainties in vitamin D measurement, the NIH/ODS will host this one-day workshop to evaluate the state of analytical methods. The intent of the Nutrient Biomarkers Analytical Methodology: Vitamin D Workshop is to develop strategies for resolving inconsistencies between results obtained following quantitative determination of selected nutrients in biological materials such as serum when different measurement techniques are used. The desired outcomes of this meeting are to identify strengths and weaknesses of analytical approaches available for the quantification of the nutritional biomarker of Vitamin D status, circulating 25(OH)D in biological samples and to discuss analytical methods, including criteria for selection of method(s); role of reference methods and samples; sample preparation and interpretation of results.

    The workshop will consist of a series of short, focused podium presentations interspersed with open discussion sessions on the currently available analytical methods and interpretation of findings. A final session will summarize the discussions, identify knowledge gaps, and suggest a research agenda for future studies.


    Registration
    Space is limited and will be filled on a first-come first-served basis. There is no registration fee to attend the workshop. To register please forward your name and complete mailing address including phone number via e-mail to Ms. Tricia Wallich at twallich@csionweb.com. Ms. Wallich will be coordinating the registration for this meeting. If you wish to make an oral presentation during the meeting, you must indicate this when you register and submit the following information: (1) a brief written statement of the general nature of the comments that you wish to present, (2) the name and address of the person(s) who will give the presentation, and (3) the approximate length of time that you are requesting for your presentation. Depending on the number of people who register to make presentations, we may have to limit the time allotted for each presentation. If you don't have access to e-mail please call Ms. Wallich at 301-670-0270.


    Workshop Details
    Agenda

    Meeting Location:

    Bethesda North Marriott Hotel & Conference Center
    5701 Marinelli Road
    North Bethesda, MD 20852
    Phone: 301-822-9200
    Website: http://bethesdanorthmarriott.com

    http://ods.od.nih.gov
    What profit is there for one to gain the whole world yet lose or forfeit himself? Luke 9:25

  • Adam Wilk

    10/29/2009 5:17:57 PM |

    Dr. Davis,
    Great post, I enjoyed the way you wrote the dialogue between you and the nurse at the hospital--very, very realistic, and kind of spooky at the same time.  Unfortunately, this is just the tip of the iceberg--from my own personal experiences with my type 2 diabetic father in the hospital, getting insulin right is a total nightmare.  They use this arbitrary sliding scale which in some cases is totally ineffective and makes for unnecessarily high sugars--I remember how my father was merely 2 days post-op and was sitting there furious because the staff thought it was okay for him to be lying there with sugars in the low 200's, based on their scales and protocols.  
    You've got to stay out of hospitals.
    Great post.
    Adam

  • Anonymous

    10/29/2009 9:57:08 PM |

    Well good luck getting anything "health promoting" while in a hospital!

    Last year, while hospitalized for a bout of Takotsubo syndrome,  they wouldn't let me use my own: fish oil, Vitamin D3, Vitamin K, multi-vitamin, compounded bi-est or progesterone, and so on...

    They did manage to have Armour thyroid available to dispense to me.  Instead of the bi-est and progesterone they offered me Prempro... shudder, and these two meds could be had at the hospitals nifty pharmacy prices.

    So 4 days without the vitamins probably did no harm... but the hormones???  Yikes, by the 2.5 day mark my husband was forced (by me) to become a criminal and smuggle the compounded meds in to me during the night.  What could they do to me that would be worse than hormone withdrawl on top of Takatsubo syndrome?  HA... don't answer that!

    I got better as quickly as I could, and got the Heck out of there.  BTW, I don't think anyone on the nursing staff understood the difference between a heart attack and Takatsubo syndrome... BIG difference!

    Oh... and I got rid of the "precipitating event" that caused the whole thing, and that has greatly de-stressed my life.

    My advice: stay away from hospitals if at all possible... unless you are a doctor, nurse or hospital administrator.

    madcook

  • Jim Purdy

    10/30/2009 6:13:46 AM |

    Great post, and great comments, especially this one from Helena:
    "Well yesterday they called me to tell me that everything was ok, but didn’t understand why I wanted to see my own lab results… the woman I was speaking to almost questioned my motive for wanting to see it. What the heck is wrong here… ???"

    That sounds so familiar. If I could just go directly to a lab without doctor's orders, I would almost drop completely out of the whole doctor and hospital system.

  • renegadediabetic

    10/30/2009 1:07:45 PM |

    I hope I never have to go in the hospital.  They will probably feed me the standard "diabetic diet," low fat-high carb, and send my blood sugar into orbit.

    They do seem very reluctant to tell you the numbers.  After my last blood test, the nurse called and said my cholesterol was "high" and the doctor prescribed simvastatin.  I had to pry the numbers out of her:  LDL - 128, trigs - 55.  I consider the "high" LDL to be a case of skewed freidenwald and haven't bothered with the simvastatin.

  • JPB

    10/30/2009 4:49:49 PM |

    Note to Jim Purdy:  You can get your own tests.  
    www.MedLabUSA.com
    www.MyLab.com
    www.HealthCheckUSA.com (I think the .com is correct but not sure.)

  • Rich S

    10/30/2009 6:53:22 PM |

    Jim-

    Try these self-directed lab test companies:

    www.directlabs.com

    or

    www.privatemdlabs.com

    I've used both of them a lot.  PrivateMDlabs even gives you a 15% discount on top of their reasonable lab test prices.

    Rich

  • Lacey

    10/30/2009 8:19:41 PM |

    JPB,

    You make a good point.  In most states, it is possible for people to go directly to labs.  However, I want to point out that a few states, including NY, prohibit people from dealing directly with labs unless you are a licensed medical practitioner. New Yorkers can't even participate in the Vitamin D project.  It's infuriating, and I think it encroaches on basic liberty.

  • Red Sphynx

    10/31/2009 1:24:19 PM |

    Any guess on how much the hospital charged the insurance company for that single pill of second rate Vit D?

  • Rich S

    10/31/2009 2:09:21 PM |

    Living in New Jersey, I too suffer from "nanny-state" laws which prohibit me from getting my blood drawn for direct-to-consumer testing in New Jersey.

    However, it is perfectly legal to order the tests and get the labwork done at a Labcorp (usually the draw site used) in a neighboring, less-restrictive state.

    I am fortunate to live in southern New Jersey 20 miles from Philadelphia, so I get my lab draws by going over the bridge to Pennsylvania.  BTW, the other nanny-states which restrict direct-to-consumer lab tests are New York and Rhode Island.

    New York even restricts "blood-spot" testing (finger-prick) done at home and mailed in, which can be used for HbA1c, vitamin D, and other tests. To get around that, folks have had the tests mailed to friends or family in other states, who then forward it.  Our politicians are truly moronic.

    Rich

  • Helena

    11/1/2009 12:17:41 AM |

    Jim, I am right there with you... and Rich - thanks for the links I will be taking a look at that since I want to make sure I stay in good range without over doing my supplements.

    Thanks Dr Davis for a great post, once again.

  • Ursula

    11/3/2009 6:46:33 PM |

    I'm a little concerned (as an RN), that the RN and the Pharm were under the impression D affected coagulation. Working in managed care, I see a ton of misconception. Im always astounded at how much a non issue nutrition is, with the exception of diabetics, renals, and your bariatric surgery patients. The only places that get it are centers like Memorial Sloan Kettering, taking a whole body approach. But even there, wrong MD on your case, and your sunk. Do not get sick, and if you do, don't try to heal in the average hospital.

  • kc

    12/5/2009 6:04:03 PM |

    I'm allergic to corn so I live in fear of having to be hospitalized. You can't even imagine all the ways they could make me sicker. The worst part is that my own doctor has told me that I couldn't possibly be reacting to a corn derivative because all the corn protein had been processed out. I can almost guarantee that they wouldn't have a medicine to treat me that didn't contain corn.

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More Omnivore's Dilemma

More Omnivore's Dilemma

Another irresistible quote from Michael Pollan’s book, The Omnivore’s Dilemma:

“In many ways breakfast cereal is the prototypical processed food: four cents’ worth of commodity corn (or some other equally cheap grain) transformed into four dollars’ worth of processed food. What an alchemy! Yet it is performed straightforwardly enough: by taking several of the output streams issuing from a wet mill (corn meal, corn starch, corn sweetener, as well as a handful of tinier chemical fractions) and then assembling them into an attractively novel form. Further value is added in the form of color and taste, then branding and packaging. Oh yes, and vitamins and minerals, which are added to give the product a sheen of healthfulness and to replace the nutrients that are lost whenever whole foods are processed. On the strength of this alchemy the cereals group generates higher profits for General Mills than any other division. Since the raw materials in processed foods are so abundant and cheap (ADM and Cargill will gladly sell them to all comers) protecting whatever is special about the value you add to them is imperative.”

A food manufacturer’s nightmare is when you and your family shop in the produce aisle in the grocery store. Produce is unmodified (aside from the pesticide and genetic-engineering issues), not added to, and therefore of no interest to the food manufacturer, since no additional profit can be squeezed out of it. If you pay 45 cents for a cucumber, there’s no room for a processor to multiply it’s return.

Vegetables and fruits have imperfections, no doubt, particularly pesticide residues and the “dumbing-down” of some foods to increase their desirability (e.g., green grapes, what I call “grape candy”). But vegetables and fruits are the closest you can get to foods that are essentially unmodified by a food manufacturer. Due to the absence of processing, they are not calorie-dense like a bag of chips; they include all the naturally-occurring healthy factors like flavonoids that food scientists have, thus far, struggled and failed to identify, quantify, and control; and they lack all the unhealthy additives that processed foods require for extended shelf life, palatability, and reconstitution (anti-separating agents, emulsifiers, sweeteners, etc.)

Vegetables, in particular, should be the cornerstone of your plaque control program. Not breakfast cereals, breads, bacon, sausage, mayonnaise, fruit drinks and soda, all the foods that worsen the causes of coronary plaque and raise your heart scan score.

If you would like to understand how the current perverted state of affairs in food have come about, Pollan’s book is must reading.

Comments (2) -

  • neil

    2/13/2007 6:46:00 AM |

    Hi Dr. Davis and Readers,

    I just got my Vitamin D (25-Hydroxy) back. Somewhat surprised...it was only 33.9ng/ml. This despite the fact I take 4,000iu of an oil based product daily (NOW brand) and live outside of Los Angeles (70 today). I do work inside however and wear long sleeve shirts, and I don't garden (no one cuts their own grass in Los Angeles). By the time I take my power walk in the evening, it is dark as well.

    I can see why Dr. Davis personally has to take 6,000iu daily in the winter. I think it would take about that, or maybe 7,000iu to get my level to 50ng/ml?

    Any thoughts? Anyone else have their levels to share?

    Neil

  • Dr. Davis

    2/13/2007 12:51:00 PM |

    Neil--

    6000 units sounds about right. I tell my patients to reduce their dose by half whenever they experience plettiful sun, e.g., midday sun in summer time. Plentiful sun is not a 5 pm walk outdoors, nor an hour outside in October, neither of which allows sufficient light intensity.

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A new Track Your Plaque record: 63% reduction

A new Track Your Plaque record: 63% reduction

Stress can booby-trap the best efforts at reducing your CT heart scan score.

But Amy, our newest Track Your Plaque record holder, defied the effects of an overwhelmingly life stress to drop her heart scan score from 117 to 43--an amazing 63% reduction.

Amy beat our previous record holder, Neal, who achieved a 51% reduction. Though Neal had dropped his score from 339 to 161, a drop of 178 and more than Amy's 74 point drop, on a percentage basis Amy holds the record.

I'm also especially gratified that a woman now holds our record. I'm uncertain why, but the ladies have been shy and the men remain the dominant and vocal participants in our program. Speak up, ladies!

Amy's complete story can be found in our latest Track Your Plaque Newsletter to be released later this week, as well as an upcoming feature on the www.cureality.com website. (We've got to toot our horn about successes like this!)

Comments (3) -

  • JT

    7/14/2007 4:33:00 PM |

    Congratulations Amy!

  • Anonymous

    7/15/2007 4:10:00 AM |

    And here I thought that plaque was in your arteries for life... and then tonight I find this blog.

    Amy (and Neal) give all of us inspiration to truly modify our lifestyle.

  • buy jeans

    11/3/2010 10:18:14 PM |

    I'm also especially gratified that a woman now holds our record. I'm uncertain why, but the ladies have been shy and the men remain the dominant and vocal participants in our program. Speak up, ladies!

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Dr. Cannell comments on vitamin D lab tests

Dr. Cannell comments on vitamin D lab tests

As always, Dr. John Cannell of The Vitamin D Council continues to teach us new lessons about vitamin D.

Apparently, Dr. Cannell is swamped with the attention that vitamin D is drawing, largely due to his efforts to publicize the enormous deficiency of Americans and his great talent for articulating the science. The most current newsletter, while a bit haphazard, makes some excellent new points that I reprint here.

(I did not reprint his conversation about "any form of vitamin D" being acceptable. My experience differs: In nearly 1000 patients who have taken vitamin D supplements, my experience is that most tablet forms are inconsistently absorbed, sometimes not absorbed at all. I therefore advocate only use of gelcaps or liquids. I'm told by members of Track Your Plaque, however, that they are witnessing reliable increases in blood levels of vitamin D by taking the powdered form of Bio Tech Pharmacal's product.)


Does it matter what reference lab my doctor uses?

Yes, it might make a huge difference. A number of methods exist to measure 25(OH)D in commercial labs. The two most common are mass spectrometry and a chemiluminescence method, LIAISON. The first, mass spectrometry, is highly accurate in the hands of experienced technicians given enough time to do the test properly. However, in the hands of a normally trained technician at a commercial reference lab overwhelmed with 25(OH)D tests, it may give falsely elevated readings, that is, it tells you are OK when in fact you are vitamin D deficient. The second method, chemiluminescence, LIAISON, was recently developed and is the most accurate of the screening, high throughput, methods; LabCorp uses it. Quest Diagnostics reference lab uses mass spec. Again, both Quest and LabCorp are overwhelmed by 25(OH)D requests. The problem is that the faster the technicians do the mass spec test, the more inaccurate it is likely to be. If your 25(OH)D blood test says "Quest Diagnostics" on the top, do not believe you have an adequate level (> 50 ng/ml). You may or may not; the test may be falsely elevated. Let me give you an example. A doctor at my hospital had Quest Diagnostics do a 25(OH)D. It came back as 99 ng/ml of ergocalciferol. He is not taking ergocalciferol (D2), he has never taken ergocalciferol, only cholecalciferol, and he is not taking enough to get a level of 99 ng/ml, 50 ng/ml at the most. His email to Dr. Brett Holmquist at Quest about why Quest identified a substance he was not taking went unanswered other than to say "any friend of Dr. Cannell's is a friend of ours."

Long story short: if your lab report says "LabCorp" on the top, it is probably accurate; if it says Quest Diagnostic, it may be falsely elevated. While LabCorp has also been overwhelmed with 25(OH)D requests, the LIAISON method they use is relatively easy to do and does not rely on technician skill as much as the mass spec methods do. I'm not saying this because I'm a consultant for DiaSorin, who makes LIAISON, I'm saying it because it is true. If you don't believe me, get Quest to make me an offer to be their consultant at 10 times what DiaSorin is supposed to be paying me ($10,000 per year) and see how fast I turn Quest down. If Quest fixes their test, I'd love to consult. The ironic thing: I've made both Quest and LabCorp lots of money via this newsletter, the website, and by repeatedly telling the press that people need to know their 25(OH)D level, which has contributed to the skyrocketing sales of 25(OH)D blood tests.

Demand for vitamin D tests soars as nutrient's potential benefits touted.

Here you can help. Find out which labs in your town use Quest Diagnostics and which use LabCorp. Have a 25(OH)D test at both labs the same day (you will have to pay for them yourself). Then send both results to the Vitamin D Council address below. If Quest Diagnostics does not fix their 25(OH)D test, the Vitamin D Council will fix it for them.



My doctor prescribed Drisdol, 50,000 IU per week. What is it?

Drisdol is a prescription of 50,000 IU tablets of ergocalciferol or D2. Ergocalciferol is not vitamin D but it is similar. It is made by irradiating ergosterol, which is found in many living things, such as yeast. D2 is not normally found in humans and most studies show it does not raise 25(OH)D levels as well as human vitamin D (cholecalciferol or D3) does. However, Drisdol is a lot better than nothing. The best thing to do, if you are vitamin D deficient, and a human, is to take human vitamin D, cholecalciferol, A.K.A. vitamin D3.



What is the ideal level of 25(OH)D?

We don't know. However, thanks to Bruce Hollis, Robert Heaney, Neil Binkley, and others, we now know the minimal acceptable level. It is 50 ng/ml. In a recent study, Heaney et al enlarged on Bruce Hollis's seminal work by analyzing five studies in which both the parent compound, cholecalciferol, and 25(OH)D levels were measured. It turn out that the body does not reliably begin storing the parent compound (cholecalciferol) in fat and muscle tissue until 25(OH)D levels get above 50 ng/ml. The average person starts to store cholecalciferol at 40 ng/ml, but at 50 ng/ml, virtually everyone begins to store it for future use. That is, at levels below 50 ng/ml, the body is usually using up the vitamin D as fast as you make it or take it, indicating chronic substrate starvation, not a good thing.

Hollis BW, Wagner CL, Drezner MK, Binkley NC. Circulating vitamin D3 and 25-hydroxyvitamin D in humans: An important tool to define adequate nutritional vitamin D status. J Steroid Biochem Mol Biol. 2007 Mar;103(3-5):631-4.

Heaney RP, Armas LA, Shary JR, Bell NH, Binkley N, Hollis BW. 25-Hydroxylation of vitamin D3: relation to circulating vitamin D3 under various input conditions. Am J Clin Nutr. 2008 Jun;87(6):1738-42.



I have advanced renal failure and I'm on dialysis, how much vitamin D should I take?

The same as everyone else. Since I have told you about commercial labs ripping you off, let's add some drug companies. Patients with advanced renal failure need activated vitamin D or one of it's analogs, available by prescription. This is very important as their kidneys cannot make enough 1,25-dihydroxy-vitamin D (calcitriol) to maintain serum calcium. However, the rest of their tissues activate vitamin D just fine and when those tissues get enough, and when the kidneys get more vitamin D, the calcitriol spills out into the blood, lowering their need for prescription calcitriol or one of its analogs. The companies that make the analogs don't like that, it means reduced sales. So these companies do nothing, the scientists behind these companies say nothing, and renal failure patients die prematurely from one of the vitamin D deficiency diseases.

Vieth R. Vitamin D toxicity, policy, and science. J Bone Miner Res. 2007 Dec;22 Suppl 2:V64-8.



When I asked my doctor for a 25(OH)D blood test, he just laughed and said it was all idiotic. What can I do?

Help me unleash the dogs of war, the plaintiff attorneys. If you read about past nutritional epidemics caused by society, such as beriberi or pellagra, you will realize that education alone will take decades. Physicians successfully fought against the idea that thiamine deficiency caused beriberi for decades. However, things are different now. The agents of change in modern America, as obnoxious as they are, are plaintiff attorneys. Once the first malpractice lawsuits claiming undiagnosed and untreated vitamin D deficiency led to breast cancer, autism, heart disease, etc., get past summary judgment, and they will, and end up in front of a jury, and they will, things will change rapidly. One of the main reason physicians do what they do is fear of lawsuits. In a matter of months, arrogance and ignorance will give way to 25(OH)D tests and vitamin D supplementation.

Goodwin JS, Tangum MR. Battling quackery: attitudes about micronutrient supplements in American academic medicine. Arch Intern Med. 1998 Nov 9;158(20):2187-91.


And, to help support Dr. Cannell's efforts (I sent him a check for $250 a few months back; time for more), here is his contact info:

John Cannell, MD
The Vitamin D Council

Send your tax-deductible contributions to:

The Vitamin D Council
9100 San Gregorio Road
Atascadero, CA 93422

Comments (9) -

  • moblogs

    7/14/2008 1:11:00 PM |

    I think Dr. Cannell's making an impact internationally. I don't think it's any coincidence that British awareness of D deficiency is rising almost in tandem - but still quite behind - with US reports.

  • Jeffrey Dach MD

    7/15/2008 10:53:00 AM |

    John Cannell and Vitamin D

    I have noticed that, thanks to the efforts of Dr John Cannell, many mainstream docs in my area have begun to order Vitamin D tests and supplement when found to be low.

    Satellite Maps of the Earth  

    Satellite maps of the earth showing UV Sunlight exposure correlate with serum Vitamin D levels, and the farther north, the lower the Vitamin D, and the higher the incidence of Cancer and Multiple Sclerosis in our population.

    These NASA space satellite photos of North America color coded for UV sun exposure can be seen on Dr. Grant's Vitamin D Web Site.  Here, you will see a pattern remarkably similar to the incidence of cancer and multiple sclerosis. This is thought to be due to differences in Vitamin D levels. The farther north with less sun exposure and lower Vitamin D levels, there is an increased incidence of cancer and multiple sclerosis.

    Diseases Caused by, or Associated With Vitamin D Deficiency:

    Again here is the list: Osteoporosis, Hypertension, Cardiovascular disease, Cancer, Depression, Epilepsy, Type One Diabetes, Insulin resistance, Autoimmune Diseases, Migraine Headache, PolyCystic Ovary Disease (PCOS), Musculoskeletal and bone pain, Psoriasis.

    Vitamin D deficiency has been reported in 57% of 290 medical inpatients in Massachusetts, 93% of 150 patients with overt musculoskeletal pain in Minnesota, 48% of patients with Multiple Sclerosis, 50% of patients with lupus and fibromyalgia, 42% of healthy adolescents, 40% of African American Women, and 62 % of the morbidly obese, 83% of 360 patients with low back pain in Saudi Arabia, 73% of Austrian patients with Ankylosisng Spondylitis, 58% of Japanese girls with Graves’s Disease, 40% of Chinese adolescent girls, 40-70% of all Finnish medical patients. (the above is from Dr Cannell newsletter)

    Low Vitamin D in Florida?

    Surprisingly, we have been seeing low vitamin D levels even here in sunny Florida demonstrated by serum 25-OH Vit D blood testing.  These people avoid the sun for fear of skin cancer.

    To read a synopsis of Dr John Cannell's excellent work...Vitamin D Deficiency by Jeffrey Dach MD

    Jeffrey Dach MD
    4700 Sheridan Suite T
    Hollywood Fl 33021
    954-983-1443
    Jeffrey Dach MD
    Natural Medicine 101

  • Anne

    7/17/2008 12:25:00 AM |

    I have found many of the vitamin D articles that say 50% or 60% or 80% of the people were vitamin D deficient are using cutoffs of 30 or even 20ng/ml. If they were to use 40-50ng/ml as the low, all but a very few would be found to be deficient.

    What I don't understand are the people who tell me their doctor put them on 50,000 IU of ergocalciferol and when the level rises, they are told to discontinue it. I know one person who has gone through 3 cycles of vitamin D supplementation. She told me her doctor is puzzled as to why her D keep dropping. This should not happen when information is so easy to access.

  • Jessica

    7/17/2008 6:37:00 PM |

    I, too, can't understand the desire of physicians to use 50,000 IU of D2, which we know is only 30% as effective as D3. Plus, it uses a prescription and costs more per pill than D3.

    A fantastic graph of Disease states and the effects of D can be found at the grassroots website Dr. Cannell referred to in his recent newsletter.

    Dr. C Grant developed the graph and with his permission, we've reproduced it and have copies of it hanging in our exam rooms. It's a very powerful tool to use when talking with patients about the important of optimizing D levels.

  • lizzi

    8/21/2008 10:56:00 PM |

    Actually Labcorp will use either chemoluminescence (081950) or mass spec (500510).  The mass spec is through Esoterica which invented mass spec, so it is probably OK.  If you prefer chemoluminescense, then specify the correct code. (081950).

  • mike V

    12/2/2008 5:17:00 PM |

    More vindication:

    http://www.sciencedaily.com/releases/2008/12/081201200032.htm
    *Preventive Vitamin D Screening Avocated*

    In their review article, published in the December, 9, 2008, issue of the Journal of the American College of Cardiology (JACC), the authors issue practical recommendations to screen for and treat low vitamin D levels, especially in patients with risk factors for heart disease or diabetes.

    "Vitamin D deficiency is an unrecognized, emerging cardiovascular risk factor, which should be screened for and treated," said James H. O'Keefe, M.D., cardiologist and director of Preventive Cardiology at the Mid America Heart Institute, Kansas City, MO. "Vitamin D is easy to assess, and supplementation is simple, safe and inexpensive."

    mikeV

  • Vitamin D Blood Test

    12/10/2009 7:10:58 PM |

    I would of never thought that about  Labcorp and quest. i would of thought that a lab test is a lab test.

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  • buy jeans

    11/3/2010 10:36:09 PM |

    The ironic thing: I've made both Quest and LabCorp lots of money via this newsletter, the website, and by repeatedly telling the press that people need to know their 25(OH)D level, which has contributed to the skyrocketing sales of 25(OH)D blood tests.

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COURAGE to do better

COURAGE to do better

The results of the long-awaited COURAGE Trial were announced today at the American College of Cardiology meetings in New Orleans.

In this trial, 2200 participants with stable coronary disease (i.e., not unstable, in which heart attack or death is imminent) were randomly assigned ("randomized") to either angioplassty/stent or "maximal medical therapy." Medical therapy means such things as aspirin, beta blocker drugs, and statin cholesterol drugs. There was virtually no difference between the groups in rate of heart attack and death from heart disease over a period of up to 7 years.

These results have caused a stir in the media and my colleagues, trying to sort out of the implications. However, I think there's one observation in particular worth making for those of us who tend to scoff at the conventional approach to coronary disease. That is, 1 of 5 people had a heart attack or died from heart disease in both groups. That's a lot. Even more ended up with a procedure (angioplasty, stent, or bypass). In other words, the "maximal medical therapy" instituted in participants was hardly a success. Though angioplasty and stenting failed to prove superiority, both really stunk. Both permitted a lot of catastrophes to occur.

"Maximal medical therapy," in other words, is a laughable concept. It doesn't include raising HDL, suppressing small LDL, reducing Lipoprotein(a), addressing inflammatory issues. It does not include omega-3 fatty acids from fish oil, nor does it address the severe degrees of vitamin D deficiency that are proving, in the Track Your Plaque experience, to be among the most potent causes of atherosclerotic plaque known. It includes a sad attempt at diet, as advocated by the American Heart Association, a diet that, in my view, causes heart disease and is distorted by the powerful political and financial influence of food manufacturers.

If the trial were to be done again, I'd like to see the "maximal medical therapy" arm be represented by a more effective program like the Track Your Plaque approach.
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Are you addicted to fructose?

Are you addicted to fructose?

Try a little experiment:

Side by side, try a yogurt made with fructose or high fructose corn syrup as one of the first ingredients on the label along with a yogurt made without fructose.

Yoplait and Dannon brands, for instance, fit the bill for fructose. Several brands do not use fructose products. Many of these are the unflavored or unsweetened versions. You may therefore have to add some blueberries, strawberries, or some other fruit for some flavor. ( I doubt that you would add high fructose corn syrup.) Add nuts, seeds, flaxseed, or oat bran to either.

Many people who do this will notice a peculiar effect: The fructose or high fructose corn syrup containing product is, to most, delicious. It also triggers a desire for more. You can't have just one--you've got to have another, or you've got to eat something else.

The non-fructose containing product is more likely to generate satiety, a feeling that you've had enough.

If you experience this effect, the solution is simple: avoid fructose and high fructose corn syrup. I believe that the most worrisome health effect of fructose is this hunger-increasing aspect, difficult to document, perhaps impossible to measure, but a great boon to the food industry who practice an "eat more" philosophy to increase revenues year after year.

Perhaps you will also see weight drop (since you will be more satisfied), see triglycerides drop (since fructose raises triglycerides), and maybe obtain all the downstream benefits of reduced triglycerides (higher HDL, less small LDL, less VLDL, more rapid clearance of post-prandial lipoproteins).

Most people who follow this idea gain better control over appetite, lose weight, and do better in health, including in their Track Your Plaque program.

Comments (1) -

  • Dana

    8/14/2007 9:33:00 PM |

    I just came across your blog, but I really like it already!  I think you have a great topic, and you address it really well.  I look forward to being a new reader!

    Visit my blog if you get a chance as well- http://asizableapple.blogspot.com

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Are happy people more likely to reduce heart scan scores?

Are happy people more likely to reduce heart scan scores?

I was talking to Darryl, a patient today: 71 years old with a heart scan score of 378, as well as an enlarged aorta (4.5 cm).

We had identified numerous lipoprotein abnormalities 12 months ago and advised him on a program for correction. His patterns included small LDL, high triglycerides, sky-high IDL (VERY important when you have an enlarged aorta), and lipoprotein(a). Blood pressure was also high, another crucial fact to correct when the aorta is enlarged.

Anyway, Darryl corrected lipoproteins to perfection: basic lipids were substantially better than 60-60-60; lipoprotein(a) was reduced well into the desirable range; IDL was eliminated; blood pressure was 108/64. Repeat heart scan score: 354.

There's nothing spectacular about Darryl's story, except that, despite these issues, Darryl was a happy man. He smiled throughout our conversation. He has told me on several occasions how grateful he is for the life he has.

Darryl is not wealthy. He retired around 4 years ago and fills his day with helping his wife, walking outdoors, helping out at his church, and contributing to the care of his grandchildren. Through all this Darryl is incurably, unfailingly, and irrepressibly happy.

It made me think back through all the other people who've also had great succes in their Track Your Plaque program. It struck me that, for the most part, they too were a happy bunch: generally optimistic, happy, not overly stressed nor prone to extremely stressful responses to stressful situations. All seem to also be grateful for the good in their lives, though most had no more money than the average person and had their share of difficulties in life. In fact, I can only recall one person who reversed coronary plaque who was an angry, pessimistic personality. Just one.

Could it be that happy, optimistic people are more likely to reverse coronary plaque? It would, after all, be consistent with all the other observations that type A personalities have more heart attack, etc.

Anyway, this is just an informal observation but one that seems very consistent. Track your plaque--and be happy!
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Protecting the right to use bio-identical hormones in your heart disease prevention program

Protecting the right to use bio-identical hormones in your heart disease prevention program

If you've been following the Track Your Plaque program, you know that we are advocates of "bio-identical hormones", i.e., hormone replacement using forms that are identical to the naturally-occuring human form.

In other words, we find it criminal that pharmaceutical manufacturers continue to promote use of non-identical hormones despite a probable increased side-effect and complication profile (a la Premarin). This unhappy situation persists because bio-identical hormones cannot be patent protected, meaning profits cannot be protected. Synthetic hormones can be patented and profits protected, thus their popularity among drug companies.

If that's not bad enough, Wyeth Pharmaceuticals--maker of synthetic hormone preparations, Premarin and Prempro--has filed an FDA petition to disallow the use of bio-identical hormones as prepared and dispensed by "compounding pharmacies". These are specialty pharmacies that mix and dispense hormones like estrogens (human estradiol, estriol, and estrione) and testosterone. They do so only with a doctor's prescription. Most are members of the Professional Compounding Centers of America (www.pccarx.com), a professional organization devoted to promoting quality-control over compounding practices.

Compounding pharmacies are occasionally guilty of compounding some suspect preparations. Witness the Fentanyl lollipops of 2002 in which the pain medication, Fentanyl, was put into lollipops for patients with chronic pain. This posed obvious dangers to any children who unsuspectingly ate the lollipops.

But the majority of compounding pharmacies are not guilty of such exotic practices. Most are simply pharmacies who might, for instance, mix a specific dermatologic preparation according to the orders of a dermatologist. Likewise with bio-identical hormones.

We have extensive experience with such a pharmacy in Madison, Wisconsin, the Women's International Pharmacy. They have filled hundreds of hormone prescription for us. They are responsible in their dispensing practices, in our experience. In fact, they have been at least as good, if not better, than other pharmacies we've dealt with.

We believe in protecting our rights to prescribe and you to use the choice of hormone preparations you and your doctor desire. This should include bio-identical hormones. The transparent profit motive from Wyeth should raise the hairs on your neck.

If you would like to post your comment to the FDA, there's a little time left. The folks at Womens' International Pharmacy have made it easy by posting links on their website. Go to http://www.womensinternational.com and just follow the instructions.



Here's a sample of some of the objections citizens have raised to Wyeth's petition:


I have been taking bioidentical hormones for two years. Bioidentical Hormones have been a great relief to me without the risk. I consult with my Physician who prescribes bio-identical hormones specifically for me, and my pharmacist prepares them. Without this medication and I would not be able to sleep; I would not be able to work due to the constant hot flashes. Without this medication, I find that I have less tolerance and I am considerably disagreeable. I also have problem with my memory without them. I want the bioidentcial hormones for the health benefits they provide. I urge you to not be swayed by Wyeth's petition. The product Premarin made by Wyeth, is made from pregnant horses not natural sources. Wyeth's hormones have been shown to cause cancer. I would not expect my government and its officials to submit to the highly funded petitioning of a pharmaceutical company who product is threatened by bioidentcial hormones. I do not expect my government to approved Wyeth's petition and leave me no choice of bioidentcial hormones and only the choice of Wyeth's cancer causing drugs Preamrin and Prempro. I ask that the FDA reject Wyeth's petition Docket #2005P-0411.

Another petitioner writes:

As a woman I take exception to Wyeth accusing the Compounding Pharmacy industry of unsafe practices. As a citizen of the United States I expect the FDA to stand up for my rights and the rights of all women who have found or in the future may seek consistent, safe and effective treatment with bioidentical hormones. Eliminating options by bowing to a large pharmaceutical company like Wyeth is not in the public interest and would deprive hundreds of thousands of American women from access to bioidentical hormones. Synthetic hormone replacement has been proven unequivocally unsafe in a government sponsored study and should not be forced as the sole treatment option for women. I hereby request the FDA rule against Wyeth's request. The FDA should not close down the bioidentical option of healthcare. I welcome studies of bioidentical hormones even though they are already FDA-approved and have been working effectively for decades. We already have the proof - hundreds of thousands of women, who over the past two decades have chosen bioidentical hormones based on their physicians' assessments. They are living proof that bioidentical hormones are safer and more effective and reliable than synthetic hormone drugs.

A physician and user of bio-identical hormones writes:

Wyeth, the filer of this complaint, is trying to prevent women from being able to choose less expensive compounded options for hormone replacement. There is medical evidence that in modifying the structure of their drugs (such as Premarin and Prempro) so that they could be patented, they may have introduced factors that cause the health risks identified in the Women's Health Initiative. This complaint appears to be filed for commercial purposes because of the market share that has shifted from Wyeth's products to bio-identical products from compounding pharmacies. If the complaint were upheld, patients and their doctors would not have a choice in hormone treatments. Wythe's commercial strategy of trying to eliminate the 'competition' from compounding pharmacies is against the public interest and in the interest of its own corporate profits. Women and their doctors should be able to choose between patented formulations such as those offered by Wyeth, bioidentical formulas available from compounding pharmacies, and no hormone treatment. I have been taking bio-identical hormones for several years and have had excellent results in improving my symptoms. I have been unable to take other synthetic hormones in the past, and am very concerned that my best treatment option will be taken away.
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