Vitamin D for $200?

What if vitamin D cost $200 rather than $2?

In other words, what if cholecalciferol, or vitamin D3, was a patent-protectable agent that would sell for an extravagant price, just like a drug?

Vitamin D would be the hot topic. There would be TV ads run during Oprah, slick magazine two-page spreads with experts touting its outsized benefits, insurance companies would battle over how much your copay should be.

The manufacturer would host large fancy symposia to educate physicians on how wonderful vitamin D is for treatment of numerous conditions, complete with dinner, a show, and gifts. They would hire expert speakers to speak, scientists to have articles ghost-written, give out knick knacks with the brand label inscribed--just like Lipitor, Actos, Vytorin, ReoPro, Plavix . . .

After all, what other "drug" substantially increases bone density (up to 20% in adult females), enhances insulin responses 30% (equivalent to the TZD drugs, Actos and Avandia), and slashes colon cancer risk?

But it's not a drug. That is both vitamin D's strength and its weakness. It's a strong point because it's natural, phenomenally helpful across a variety of conditions, and inexpensive. It is also a weakness because, at $2 a month, no one is raking in the $12 billion annually that Pfizer makes for Lipitor that allows it to fund an enormous marketing campaign.

Vitamin D is a "discovery" of huge importance for health, including making reductions of CT heart scan scores far more likely for more people. And it comes without a prescription.

Comments (2) -

  • Edward

    3/14/2007 8:34:00 AM |

    http://www.ajcn.org/cgi/content/abstract/85/3/860
    This recent research shows the poor Vitamin D status of most UK white residents. 87% lower than ideal in Winter and 60% remain so throughout the year. Goodness knows what the situation is for those with brown or black skins but it will inevitably be worse as it takes longer for darker skins to make the same amount of D3.

  • Neil

    3/15/2007 12:42:00 AM |

    Poster Edward and Dr. Davis, I have been reading quite a lot about vitamin D, the subject to me is absolutely fascinating. Edward, your thought about darker skin pigmentation and low vitamin D status is verified throughout medical literature and news articles. Like this...

    "...92 percent of African-American babies and 66 percent of white infants found to have inadequate vitamin D concentrations in their blood at birth." Link… http://tinyurl.com/2xpjse

    This especially gives one pause when you then consider the rate of cardiovascular disease, cervical, colorectal, lung, and prostate cancers, hypertension, fibromyalgia, Alzheimer's, and diabetes run much higher in the African American community, sometimes as much as 100-200% higher for some of these diseases.  Since these are all conditions strongly associated with vitamin D status, could it be all they need is this inexpensive vitamin supplement on an ongoing basis? And these strong associations with vitamin D status and rate of these serious diseases hold true for other racial backgrounds. One study of Southeast Asians living in England found they had a low Vitamin D status as well.

    To quote Dr. Davis from the other day "The whole vitamin D "discovery" sometimes worries me. Vitamin D has proven to be an unbelievable, remarkable, dramatic boon to health, including facilitation in dropping CT heart scan scores. Yet the answer was always right in front of us. It worries me that you and I might have the answer to important questions right within our grasp all along--but don't know it. What if the same were true, say, for cancer? That is, a profound answer is right there, but our eyes just pass right over it."

    In my recent reading I have run across so many articles on vitamin D that are just so stunning that I saved them.

    "Vitamin D deficiency is a major contributor to chronic low back pain in areas where vitamin D deficiency is endemic." Link...  http://tinyurl.com/2u4ayp

    “…...the vitamin plays a role in shutting down or activating at least 100 genes, many of which are involved in preventing diseases....family members of the Alzheimer's patients reported how well they were performing and acting within weeks of being put on large doses of prescription vitamin D, said lead author Robert Przybelski, an associate professor of geriatric medicine at the University of Wisconsin.”We hypothesize that good vitamin D levels might prevent or mitigate the disease," Przybelski said.”  Link… http://tinyurl.com/2uk2hy


    “…the deadliness of the 1918 killer flu could have been largely a result of vitamin D deficiency. Worldwide, an estimated 25 million people died from that flu.” Link… http://tinyurl.com/33ogga

    “…With respect to the modulation of cardiovascular effects by 1 ,25-(OH)2D3, further investigations are needed that could eventually lead to novel pharmacological approaches to manage hypertrophy, restenosis, and atherosclerosis or remodel the cardiovascular system.” Link… http://tinyurl.com/36897n

    “…71% of patients with severe PAD had serum 25-hydroxyvitamin D [25(OH)D] levels that were below 9 ng/mL” Link…  http://tinyurl.com/2gqe3r

    How could a two dollar a month supplement do all this!!! Pretty incredible stuff.

    My own family tree is littered with victims of cancer, heart attack (leading to sudden death MI’s in my Uncle and Grandfather both at the age of 52), stroke, Alzheimer’s, ALS, etc. Could vitamin D have been a strong contributing factor to their deaths??? Considering my own vitamin D level was EXTREMELY low and I now have to take about 6,000 IU daily just to normalize it, and I as well had a heart attack at 46, I consider this idea at least as a possible common factor.

    Dr. Davis...Thanks for keeping us informed on your patient experiences and your latest thoughts on Vitamin D and all the other treatments you are exploring. Your daily observations through your blog have helped me a great deal in becoming healthier. Reading your blog and webpage are constant sources of inspiration as well.

    Neil

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Wheat and the hunger factor

Wheat and the hunger factor

Low carbohydrate diets are becoming increasingly popular. In my experience, they also work exceptionally well.

However, I have observed a specific aspect of low-carb diets that deserves special attention: When wheat products in particular are eliminated, hunger plummets enormously.

It seems peculiar to wheat. Other high-glycemic index carbohydrates like a baked potato or white rice, for instance, don't seem to have the capacity to trigger appetite like a handful of pretzels or crackers can. There are exceptions: processed sweet drinks that contain high-fructose corn syrup can stimulate appetite, as do foods made with processed corn and corn starch.



However, wheat has grown to occupy an enormous part of diet, partly because of the "high-fiber" trickery that causes us to believe that wheat is healthy, but also, I'm convinced, because of wheat's hunger factor.


A reader of the The Heart Scan Blog recently made this comment:

I discovered this blog and Dr. Davis' TYP program at the beginning of September. I have relatively successfully cut carbs and grains from my diet thus far.

Because I've got some weight to lose, I have tried to keep the carb count low and I've lost 15 pounds since then.

I have also been very surprised at the significant reduction in my appetite. I've read about the experience of others with regard to appetite reduction and couldn't really imagine that it could happen for me too. But it has.

A few weeks ago, I attended a party catered by one of my favorite Italian restaurants and got myself offtrack for two days. Then it took me a couple of days to get back on track because my appetite returned.

Check out Jimmy Moore's website for lots of ideas about variations of foods to try. The latest thing I picked up from Jimmy is the good old-fashioned hard boiled egg. Two or three eggs with some spicy hot sauce for breakfast and a handful of almonds mid-morning plus a couple glasses of water and I'm good for the morning no problem.

I find myself thinking about lunch not because I'm really hungry but out of habit.

The cool thing too now is that the more I do this, the more I'm just not tempted much to do anything but this diet.



I, too, have personally experienced this effect. I also was skeptical. It made no sense. How can whole grain bread increase appetite? I don't know what it is about wheat products that make them especially powerful triggers of appetite. I think that it probably goes beyond glycemic index, perhaps some other component besides taste.

But if you want to seize control over appetite, elimination--not reduction--but elimination of wheat, as well as other processed carbohydrates, can really change the way you approach food. (Interestingly, The Wheat Foods Council estimates that the average American eats 144 lbs of wheat flour per year; they argue that it should be increased 210 lbs per year!)

Eliminating wheat products is also an effective tool in the Track Your Plaque program for raising HDL, reducing triglycerides, reducing small LDL, and reducing both blood sugar and blood pressure. And it can be among the most effective ways to control appetite, since eliminating wheat also eliminates its hunger factor.

Foods to consider to take up the calorie slack when eliminating wheat: cheese (fermented, of course, for vitamin K2 content); eggs, as our reader pointed out; other lean proteins like lean red meats, fish, chicken, turkey; more liberal use of healthy oils like olive and flaxseed; plenty of raw nuts and seeds; soy milk and tofu. Obviously, the center of your diet should remain vegetables.

Comments (20) -

  • Windminstrel

    10/28/2007 12:56:00 AM |

    Doc, what's your thoughts about oats as a wheat supplement? From what I've read, oats don't have the insulin effect of wheat, and have a positive effect on heart health.

  • Dr. Davis

    10/28/2007 2:25:00 AM |

    I think you mean as a wheat replacement? Yes, it is indeed a great replacement, along with flaxseed. Both exert effects on reducing both LDL and small LDL, opposite that of wheat.

  • Nancy M.

    10/28/2007 5:19:00 AM |

    I think it is a pretty easy explanation, wheat contains starches that cause a release of insulin.  Insulin is a powerful hormone that makes you hungry.  Gary Taubes book cites studies where insulin was injected directly into mice and guess what?  The mice eat like pigs.  Then the dropping blood sugar makes you hungry again.  

    Ever notice how you get hungrier when you start eating?  That's the first release of insulin and it whets the appetite.  The next release of insulin is slower and bigger (if you're eating lots of carbs).

    One of the nicest parts of a low carb diet is you get rid of all these cravings and crazy hunger because insulin is released much more normally.

  • jpatti

    10/28/2007 12:12:00 PM |

    Barley is a darned good grain also.  More antioxidants than blueberries!

  • Dr. Davis

    10/28/2007 12:48:00 PM |

    Yes, I agree.

  • dotslady

    10/28/2007 1:30:00 PM |

    This is absolutely true for me.  I was a victim of the '80s lowfat diet craze - doc told me I was obese, gave me the Standard American Diet and said to watch my fat (I'm not a big meat eater, didn't like mayo ... couldn't figure out where my fat was coming from!  maybe the fries - I will admit I liked fries).  I looked to the USDA food pyramid and to increase my fiber for the constipation I was experiencing.  Bread with 3 grams of fiber wasn't good enough; I turned to Kashi cereals for 11 years.  My constipation turned to steattorrhea and a celiac disease diagnosis!  *No gut pains!*  My PCP sent me to the  gastroenterologist for a colonscopy because my ferritin was a 5 (20 is low range).  Good thing I googled around and asked him to do an endoscopy or I'd be a zombie by now.

    My symptoms were depression & anxiety, eczema, GERD, hypothyroidism, mild dizziness, tripping, Alzheimer's-like memory problems, insomnia, heart palpitations, fibromyalgia, worsening eyesight, mild cardiomyopathy, to name a few.

    After six months gluten-free, I asked my gastroenterologist about feeling full early ... he said he didn't know what I was talking about!  *shrug*  

    But *I* knew -- it was the gluten/starches!  My satiety level has totally changed, and for the first time in my life I feel NORMAL!  

    Most of the above symptoms have resolved themselves, except the heart palpitations... Any suggestions?  (Doc seems to only look at thyroid:  Synthroid just reduced again to 100mcg from 175 mcg last year, but I’m still having them, esp w/low bp 96/59)   (I'm losing weight eating no white foods.)

    Just heard the tail end of a Gary Taubes interview on XM radio and he mentioned something about low bp and heart ... hmmm.

  • Anonymous

    10/28/2007 3:29:00 PM |

    My life changed when I cut not only all wheat, but all grains from my diet.

    For the first time in my life, I was no longer hungry -no hunger pangs between meals; no overwhelming desire to snack.  Now I eat at mealtimes without even thinking about food in between.

    I've dropped 70 pounds, effortlessly, come off high blood pressure meds and control my blood sugar without medication.

    I don't know whether it was just the elimination of grain, especially wheat, or whether it was a combination of grain elimnation along with a number of other changes, but I do know that mere reduction of grain consumption still left me hungry.  It wasn't until I elimnated it that the overwhelming redution in appetite kicked in.

    As a former wheat-addicted vegetarian, who thought she was eating healthily according to all the expert advice out there at the time, I can only shake my head at how mistaken I was.

  • Nyn

    10/28/2007 6:16:00 PM |

    I've been reading your blog for some time, and eliminating wheat sounds like a great thing...but what do you eat? I'm hypothyroid and have been told to avoid soy products because it interferes with the absorption of thyroid meds. I'm lactose intolerant, so I'm avoiding dairy as much as possible (I miss cheese!), and I've recently been given a diagnosis of IBS. My MD said to avoid raw vegetables and fruits. That leaves eggs, lunch meant, and almonds for protein. Cooked vegetables are very difficult to include in my daily diet when the majority of my meals must be transported. I am at a loss as to where to even begin...and I already eat too much rice because that's one of the things I can consume without discomfort. Needless to say, I am gaining weight... What does someone in my predicament eat to control hunger?

  • Cindy Moore

    10/28/2007 6:44:00 PM |

    While I have no doubt some are sensitive to wheat, personally I think it's the total carbs in any given meal that regulates appetite. For me, an piece of fruit increases my appetite just as much, if not more than a piece of bread!

  • Dr. Davis

    10/28/2007 8:28:00 PM |

    Wow. Tough predicament.

    I won't pretend to have a full solution but some thoughts:

    1) Many lactose intolerant people can handle yogurt and cottage cheese, often some cheese.

    2) You've just got to bit the bullet and cook your vegetables. If vegetables are the number one most important food in your diet, you simply need to find a solution.

    3) Nuts-lots! Seeds, too, like sunflower and pumpkin.

    4) Low-glycemic index grains like oats, barley, and flaxseed (ground). Perhaps Ezekiel bread might be a compromise worth trying.

    5) More oils.

    6) Rice should be wild.

    7) Squashes

    8) Avocados-transportable, too.

    9) Do you and your doctor feel that ALL raw vegetables trigger IBS symptoms? In my experience, it's just selected vegetables.

    No doubt about it. You've got it tougher than most.

  • Dr. Davis

    10/28/2007 9:18:00 PM |

    dotslady--

    Re: palpitations. Have you addressed the omega-3 and magnesium issues? There may also be real issues to consider by your doctor, e.g., your potassium level and blood pressure control. Underappreciated high blood pressure issues can trigger palpitations. In my experience, this is very common.

  • Nancy M.

    10/29/2007 6:35:00 PM |

    I'm betting the doctor told nyn to cook her veggies, and avoid soy, because many are goitrogenic (work to make thyroid hormone unusuable).  I think any of the veggies in the brassica family are like broccoli, brussel sprouts.  I know turnips are (I love raw turnips), and soy is too.

    If you've got refrigeration and a microwave handy, bringing your meals is pretty easy.  I used to bring all kinds of things to work that would probably work for you.  One of my favorites is a big salad with meat, nuts and a simple olive oil and rice vinegar dressing.  Cooking veggies shouldn't be a problem reheating them in the microwave.  I tend to use lots of frozen veggies and just microwave them and drizzle butter or EVOO on them.

    I follow the Paleo diet pretty closely.  It eliminates all grains, legumes, and dairy products.  My autoimmune diseases are much, much better now too.

  • Nyn

    10/29/2007 6:44:00 PM |

    nancy m & all, thank you for the suggestions. I will look into more cooked veggies. I hate cooking, and am very unhappy with this new way of eating and lifestyle. I am trying to plan ahead, and this site has really helped me. I'm trying to get past the denial stage and move on with things. I wish there was a list of things to eat, like a meal plan, somewhere. I am still looking. Great advice here.

  • G

    11/2/2007 5:33:00 AM |

    hi nyn -- i've never heard that you have to avoid certain foods when you are taking Synthroid -- you do need to avoid taking calcium and other minerals being co-adminstered at the same time as the Synthroid. Calcium (or magnesium or other cation minerals bind Synthroid and inactive the drug). A recent study showed that taking thyroid replacement medications at bedtime on an empty stomach has the most optimal effects and absorption. so i tell patients to take Levothroid or synthroid when they brush their teeth at night (assuming they brush daily) and at least 1-2 hrs AFTER any dairy, milk, ice cream, multivitamins (esp containing minerals), TUMS, antacids, etc.  I don't see a food interaction otherwise with thyroid medications.
    I hope your doc is aware that the new AACE Hypothyroid guidelines is to shoot for TSH between 0.2 and 3.0.  Many labs still have 5.5 as the 'normal' upper limit.  This is no longer correct.  So, if your TSH is greater than 3.0, you are likely still suffering from hypothryoid signs and symptoms. getting corrected (meaning, more medication) will get the TSH down to optimal goal < 3.0 and will prevent complications related to hypothyroidism (ie, high BP, insulin resistance, dyslipidemia, PALPITATIONS, feeling plain crappy, wt gain and even osteoporosis!)  i hope that helps!  IBS is tough -- my husband has it too -- developed when he commuted 1h each way to see me during pharmacy school!  aint stress bad bad bad!!!  once you get IBS you never get rid of it... good news, it can be improved...
    sugar-free metamucil (or other fiber source -- take 1-2 scoops with a VERY LARGE glass of water daily) is the cornerstone treatment (it works for most people I know) along with stress REDUCTION! go to a day spa weekly and get yourself a therapeutic massage (*doctor's orders!*  *ha haaa* no kidding!  good luck!!

    (of course i hope you followed DR. D's advice on getting checked out for your baseline vitamin 25(OH)D test?  Hashimoto's hypothyroidism is autoimmune and therefore can be associated with hypovitaminosis D, ie, inadequate Vitamin D stores in the body.  get your sunlight/ supplements if you need it!! I'm deficient myself... and in denial...  but i'm so grateful I came across this blog to even become aware of this epidemic)

  • dotslady

    11/4/2007 3:32:00 PM |

    Dr. D - Re: magnesium and potassium, last check they were in range.  I wanted to get baselines before trying supplements, so I just got my vit D checked also (not sure he did correct test, but D3 was 20, D2 was 10 = 30 and he said it was fine!).  I haven't been taking omega-3s, so will start and let you know how it goes!  Thanks for your help.  I appreciate everything you write!

    nyn - another thought re: IBS.  Could be a symptom of celiac disease at worst, gluten sensitivities at least.  Maybe giving up gluten grains will help repair your villi/gut(if indeed that's a problem) and allow fresh veggies, etc. at a later time once healed.  Smile Have you done an elimination diet and rotated foods before?

    Healing time varies depending on severity of villi damage.  Consider researching celiac symptoms & websites, maybe read about the Specific Carbohydrate Diet by Elaine Gottschall(google)?  Read:  Gluten-Free Living for Dummies by Danna Korn before changing your diet.  Consider if you want a celiac diagnosis on your health or life insurance records ...

  • G

    11/6/2007 3:31:00 AM |

    I'm an incurable yoga addict now(nothing special... just 'gym' *translation... 'FREE'* yoga!) but i've done some research and the benefits are huge. it's been around forever > hundreds of years and there must be a reason...

    benefits:
    1. reduction in stress/cortisol and improved relaxation (cortisol is 'toxic' injuring brain cells, increasing visceral fat in the abdom cavity which clogs arteries to the heart, liver and other organs, and increases glucose and therefore inflammation/free radicals)
    2. many poses  'massage' internal endocrine glands including the adrenals, parathyroid and THYROID tissue (which help remove stagnant toxins and improve internal circulation)
    3. has helped me to make the magnficient realization that all things are connected in life (whether we like it or not, ie friends-foes, black-white, ying-yang, et cetera) -- just like how all the organs and limbs and the mind are uniquely linked in our own bodies. when one thing is injured/hurt/malignant, it goes and affects e-v-e-r-y-t-h-i-n-g else. For instance I had a recent shoulder injury, and now if I don't do the appropriate exercises to maintain its strength, I unfortunately get referred pain and tension to my neck and back.
    4. all the tendons, ligaments and small muscles in the back need to be exercised and kept strong in order to support the back. yoga helps to accomplish this otherwise the back cannot do what it needs to do effortlessly and painlessly.  MUCH LIKE THE AMAZING COMMUNITY HERE -- we all support each other and keep our bodies, minds, and spirit STRONG. I'm so grateful to Dr. D for all his advice, accessibilty and ever endeavoring persistence to improve our greater health. May you ALWAYS be blessed. (and that your house doesn't get TP'd when more truths are exposed). Keep up the excellent work! THANK YOU, G

  • Dr. Davis

    11/6/2007 12:10:00 PM |

    Thanks for the kind comments, G.

    I agree with you about the yoga. Having tried it over the years and doing it on occasion with my wife, I believe that you are absolutely right.

    Bring on the TP!

  • Anonymous

    11/12/2009 3:47:54 AM |

    heartscanblog.blogspot.com is very informative. The article is very professionally written. I enjoy reading heartscanblog.blogspot.com every day.

  • Anonymous

    8/10/2010 5:21:38 AM |

    I have been wheat free for 2 and 1/2 months, and have to agree 110% on the hunger factor.  Thanks for getting the word out there.  It has made me wonder if companies know this and use it in their favor? Also if this is one of the big triggers in the US weight problem?  And how sad if people don't know this, that they think they simply have no will, when it is really the wheat.  We have also noticed that it is difficult to find cat or dog food (dry) without wheat in it!   Our outdoor cats are constantly hungry, even though it seems like they have more than enough food, I wish we could find a wheat free cat food, and see if they eat less.  Thanks again for the article.

  • buy jeans

    11/3/2010 2:23:48 PM |

    But if you want to seize control over appetite, elimination--not reduction--but elimination of wheat, as well as other processed carbohydrates, can really change the way you approach food. (Interestingly, The Wheat Foods Council estimates that the average American eats 144 lbs of wheat flour per year; they argue that it should be increased 210 lbs per year!)

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Vitamin D toxicity?

Vitamin D toxicity?

"My primary care doctor said to stop the vitamin D because it's toxic. So I stopped it and I just take a multivitamin. He said that a multivitamin and two glasses of milk a day was all I needed."

So proclaimed Eleanor to me. This happens around once every week by doctors frightened of the vitamin D.

So I reminded Eleanor that, before starting vitamin D supplementation, her blood level of 25-OH-vitamin D3 had been 17 ng/ml--severe deficiency.

On 4000 units per day (oil-based gelcap), her blood level had been 37 ng/ml--still deficient, below the desirable range of 50-60 ng/ml. That's the dose Eleanor's doctor had declared "toxic."

When exactly does deficiency develop? There's not full agreement on this, but Dr. Michael Holick of Boston University, among the most experienced and insightful authorities on vitamin D, states that toxicity is more likely when blood levels exceed 150 ng/ml (Nutr Clin Pract. 2007 Jun;22(3):297-304).

In other words, Eleanor and her doctor should not be concerned with toxicity, but with the persistent levels of deficiency she is suffering.

Some authorities call the behavior of vitamin D "bi-phasic": Deficiency is toxic, excessive levels are toxic. We're really just trying to achieve a middle ground in vitamin D levels that are above deficiency but below toxicity.

In reality, deficiency is exceptionally common. In fact, it's the rule around here (northern U.S.), with >95% of everybody we check severely deficient in winter, mildly-moderately deficient in summer. Very few people approach normal levels year round without supplementation.

Toxicity, on the other hand, is exceedingly rare. I have seen it once in a woman who was taking a toxic dose of 50,000 units a day on the instructions of her (mis-guided) doctor. Thankfully, no ill-effects developed from this little "experiment."

So, it's not toxicity that is the overwhelmingly common worry, but deficiency, severe and sustained.

Comments (3) -

  • Anonymous

    6/1/2007 7:48:00 PM |

    Thank you ! I dont know if your message could be any  clearer, but unfortunately it may take even more hounding on this as there is alot of resistance and ignorance to overcome on this subject. So please keep up this effort on vit d !  

    Thank you !

  • Mo

    11/10/2007 8:33:00 PM |

    Toxicity had worried me as my brother was taking 50,000 D2 twice a week for 6 months when he should've been taking 10,000 D2 twice a week (GP mixed up 0.25 with 1.25MG and we didn't have the knowledge to realise this until much later!)...But he's alright after that. No tests done, but no symptoms were evident too.

    Certainly if he was deficient, he'd be suffering from seizures and leg weakness again.

    In D's case, it's probably better to drink a bath full of water than die of dehydration.

  • Dr. Davis

    11/10/2007 11:16:00 PM |

    Uh,oh.

    Before you assume that your brother is toxic, however, keep in mind that he is taking vitamin D2, not the HUMAN form D3. D2 is inefficiently converted to D3. In my experience, in fact, very little is converted. In my opinion, prescription D2 is an utterly worthless preparation.  

    Why would a drug manufacturer distribute D2? I don't know for certain, but I suspect it originally was the same reason women are prescribed horse, rather than human, estrogens: profit, pure and simple. D2 is, in my view, miserably ineffective for replacing the truly active human form of vitamin D--D3.

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Are endogenous nutritional supplements better?

Are endogenous nutritional supplements better?

Just a muse.

Endogenous substances are those that are already contained within our bodies. They are part of basic human equipment.

Exogenous substances are those that come from outside of our bodies. This includes various substances in foods, drugs (most, though not all), and pesticides.


I often mull over all of the tools we use in the Track Your Plaque program to achieve control over this thing called coronary plaque. It struck me that just about all the supplements we use that seem to provide outsized benefits are all endogenous substances themselves:

--Omega-3 fatty acids from fish oil
--Vitamin D
--l-arginine
--Niacin (vitamin B3)

Many of the other substances, though not directly relevant to our plaque-control efforts, but are among the most effective nutritional supplements, also supplement endogenous levels: calcium pyruvate, creatine, acetylcarnitine, DHEA, testosterone, progesterone, growth hormone, pregnenolone, phenylalanine, tyrosine, melatonin, etc.

Curiously, most drugs are not meant to directly supplement endogenous levels, but are designed either to enhance or block an enzyme (e.g., acetylcholinesterase inhibitors that block breakdown of acetylcholine; HMG CoA reductase inhibitors to block cholesterol synthesis; angiotensin converting enzyme inhibitors to reduce blood pressure), to exert toxic effects on an organism (antibiotics, antivirals), or to exert an entirely unique effect that does not ordinarily occur in the human body (some anti-cancer drugs, for instance). (This is an admitted, vast over-simplification.)

That's not to say that any endogenous substance is desirable or safe when supplemented. Cortisol, thyroid hormone, and estrogens are three examples of endogenous substances that have downsides when administered at slightly more than physiologic concentrations.

Nonetheless, it makes me wonder if the world of endogenous substance supplementation has not been fully explored. Are there other endogenous substances that are as potent and wonderful, for instance, as vitamin D but not yet fully appreciated? I'm sure there are.

Comments (6) -

  • Anonymous

    5/3/2008 11:20:00 PM |

    I don't know if this would qualify as an endogenous substance, but I've recently added the herb turmeric to my supplementation list. I take a capsule or two a day.  I'm on an e-mail list for supplement studies and marketing going on in health food circles, and it seems tumeric is receiving good press for its ability to help strengthen bones. Figure with the connection between brittle bones and heart disease, it's worth taking a little.

  • Jenny

    5/4/2008 12:43:00 PM |

    Dr. Davis,

    You mentioned that estrogen is a natural substance that causes problems if administered at higher than physiological levels.

    You do know, I hope, that all the data showing supposed problems from estrogen supplementation is from research studies where women were given MUCH too high doses. I've been using a dose of non-horse origen estrogen about 1/4 of what they used the studies and it makes a huge positive difference in my blood sugar, blood pressure, and weight with no negative effects on my endometrium (which my doctor has me get measured with ultra sound every so often.

    I'm very grateful that I have a good gynecologist who didn't react mindlessly to the research showing negative outcomes from estrogen.

    It appears to be protective against macular degeneration (which made my dad blind in his 90s) and for me it makes blood sugar control much, much easier.

    But the usual dose given women is much, much too high, and it isn't adjusted for body weight or titrated by observing symptoms. And hence the whole idea of supplementation has been nixed.

  • Anne

    5/4/2008 9:37:00 PM |

    That is interesting about the bones and tumeric. I recently added curcumin because my fibrinogen level was elevated. Maybe it will help with my bone loss too. That would be great.

    What is the difference between tumeric and cucurmin? Does it matter which I take? I could not find tumeric but I did find cucurmin 500mg.

  • Anonymous

    5/5/2008 1:57:00 PM |

    Hi Anne,

    I guess it is the curcumin found in the spice turmeric that is receiving positive press.  As mentioned I've seen some on bone health studies but have also seen heart health and diabetes write-ups too.  I'll post below a recent small rodent research paper on diabetes benefits of curumin:

    Curcumin may offer diabetes benefits: study
    By Stephen Daniells

    KEYWORDS

        * Phytochemicals, plant extracts

        * Diabetes

    GET THE LATEST MARKET REPORTS

        * curcumin
        * diabetes
        * cardiovascular health

    All market reports

    30-Apr-2008 - Curcumin, the natural pigment that gives the spice turmeric its yellow colour, could have benefits for diabetics, suggests a joint Korean-American study.
    A mouse model of diabetes was used to test the effects of curcumin on various variables and significant improvements were reported for insulin resistance and glucose tolerance, report the scientists from Sunchon National University and Kyungpook National University in Korea, and Columbia University in the US.

    Curcumin has increasingly come under the scientific spotlight in recent years, with studies investigating its potential benefits for reducing cholesterol levels, improving cardiovascular health, reducing the risk of Alzheimer's, and potential protection against cancer.

    If results of the new study, published in the journal Molecular Nutrition & Food Research, can be repeated in humans, it may suggest potential for the spice for diabetes management or prevention.

    Promising results for diabetic mice

    The researchers, led by Mi-Kyung Lee, used diabetic mice, so-called db/db mice, and non-diabetic controls, named db/+. The animals were fed diets with or without added curcumin (0.02 per cent) for six weeks.

    They report that the diabetic mice supplemented with curcumin experienced lower blood glucose levels, than the controls. The animals also lost less weight.

    Activity of the glucokinase enzyme in the liver was higher in the diabetic mice following the curcumin-supplemented diet than in the diabetic control group. This enzyme plays a key role in the conversion of glucose into glycogen, the body's main carbohydrate stores. This would blunt the glucose rise following the meal.

    The spice was also linked to reduced activity for other enzymes associated with the production of markers of cardiovascular health, such as free fatty acids, cholesterol, and triglyceride were also significantly lower following curcumin supplementation in the diabetic animals.

    Importantly, no effects were observed on blood glucose, plasma insulin, and glucose regulating enzyme activities in the non-diabetic animals, stated the researchers.

    "These results suggest that curcumin seemed to be a potential glucose-lowering agent and antioxidant in type 2 diabetic db/db mice, but had no affect in non-diabetic db/+ mice," they concluded.

    Potential market opportunities

    Significant additional research needs to be performed before anyone can contemplate recommending curcumin for diabetics, but if further studies support these preliminary positive findings, this may offer help for the estimated 19 million people affected by diabetes in the EU 25, equal to four per cent of the total population. This figure is projected to increase to 26 million by 2030.

    In the US, there are over 20 million people with diabetes, equal to seven per cent of the population. The total costs are thought to be as much as $132 billion, with $92 billion being direct costs from medication, according to 2002 American Diabetes Association figures.

    Source: Molecular Nutrition & Food Research
    Published online ahead of print 8 April 2008, doi: 10.1002/mnfr.200700184
    "Effect of curcumin supplementation on blood glucose, plasma insulin, and glucose homeostasis related enzyme activities in diabetic db/db mice (p NA)"
    Authors: K.-I. Seo, M.-S. Choi, U.J. Jung, H.-J. Kim, J. Yeo, S.-M. Jeon, M.-K. Lee

  • Richard A.

    5/6/2008 6:57:00 PM |

    Turmeric is about 4% curcumin. Turmeric and curcumin need fat like Vitamin d to be best absorbed. Lecithin also improves absorption.

  • Physical Therapy Supplies

    6/13/2011 7:46:31 AM |

    As much I know the large doses of cretin monohydrate are widely taken, particularly by athletes, as an endrogenic supplement; cretin supplements are also taken by patients suffering from gyrate atrophy, muscular dystrophy, and neurodegenerative diseases.
    Physical Therapy Supplies

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Can vitamin D be a SOLE risk factor?

Can vitamin D be a SOLE risk factor?

Here's a crazy question. It occurred to me as I was talking to Drew, a slender, active 54-year old dentist with no bad habits including no smoking.

Drew's heart scan score was 222. His lipoprotein analysis mostly revealed a lot of nothing, which is unusual. The only pattern that showed up was a modestly high LDL of 122 mg/dl with a very slight excess of small LDL. That's it. I would not be satisfied that these were sufficient cause for Drew's level of coronary plaque.

Drew's 25-OH-vitamin D3 level: 15 ng/ml--severe deficiency--despite the fact that his doctor had suggested that he take a vitamin D2 preparation. In other words, Drew had been profoundly deficient, probably for years.

Given the unimpressive cholesterol and lipoprotein values, could vitamin D serve as a trigger for coronary plaque all by itself?

I don't have an answer and know of nobody else who does. However, my opinion is that vitamin D is indeed a potent risk that can cause heart disease as a sole risk factor.

Perhaps it's another piece of circumstantial evidence suggesting that vitamin D has an enormous influence on health, including coronary plaque. Interestingly, the only other health problem Drew has had is prostate cancer, treated a few years ago with prostate removal and radiation. Good evidence suggests that vitamin D deficiency escalates risk of prostate cancer substantially.

By the way, I've seen people taking vitamin D2 preparations, called "ergocalciferol," who are every bit as deficient as those who take no vitamin D at all. Avoid D2 or ergocalciferol preparations: they're worthless.

Comments (6) -

  • Regina W

    1/17/2007 10:20:00 PM |

    I'm probably way off here, but vitamin D derivatives are mainstays of topical therapy for chronic plaque psoriasis; I have to wonder if coronary plaque can form if vitamin D is deficient since vitamin D is involved with insulin regulation and insulin and hyperglycemia is also implicated in heart disease; often those with diabetes are found deficient in vitamin D, and they're a population most at risk for heart disease?  Makes you wonder, doesn't it?

  • Dr. Davis

    1/18/2007 1:08:00 AM |

    You're absolutely right. There is solid evidence that vitamin D deficiency increases diabetic patterns, including higher blood sugar and insulin levels. Whether this is part of the reason why vitamin D might exert benefits on coronary plaque remains uncertain. I suspect that there are many reasons, this being a major one.

  • Anonymous

    1/21/2007 1:46:00 PM |

    You may be interested in the following papers.
    The case against ergocalciferol (vitamin D2) as a vitamin supplement.
    http://www.ajcn.org/cgi/content/abstract/84/4/694
    Risk assessment for vitamin D
    http://www.ajcn.org/cgi/content/abstract/85/1/6
    http://www.ajcn.org/cgi/content/full/77/1/204
    Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol

  • Rich

    11/12/2007 9:17:00 PM |

    Dr. Prendergast has posted today an astonishing story of benefit from D3. The patient was switched to D2 in an effort to move to generic alternatives and he went rapidly downhill toward death. The mistake was discovered, the patient was switched back to D3 and he immediately recovered.
    Here's the link to the short video:
    http://enews.endocrinemetabolic.com/2007/11/generic-wars.html

  • Dr. Davis

    11/12/2007 11:44:00 PM |

    Thanks for the heads-up, Rich. It is truly an astonishing story.

  • Neelesh

    12/5/2007 5:11:00 PM |

    Dr Davis!
       Sometime back I had posted a comment on your entry about wheat. And you had suggested that my Vitamin D3 levels might be low. Your diagnosis from 3000 miles away proved right! I had a 25-OH-D3 test and the value was less than 4ng/ml. I consulted my cardiologist and he brushed away the fact and asked me to drink more milk! I'm planning to switch doctors now.
       My copy of TYP reached me and I'm through cover to cover. The level of  details in the book is amazing and I've started correcting my lifestyle, food habits and medicines(of course, after discussing with the doctor).
       Many doctors here prefer a CT angiogram to a heart scan. My doctor was unable to give a good reason for why I should not have a heart scan but a CT angiogram. ("You are too young to have a heart scan"). So the situation here in India is no better.
      Many thanks!
    -Neelesh

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