I suspect gluten sensitivity could play a role in many thyroid cases.  Celiac disease associates with autoimmune thyroid problems.  About 12% of Americans are verifiably gluten sensitive.  The number may actually be much higher if you include people who have a less pronounced immune reaction to gluten.  What do you think of this idea?

That is very concerning. What are the typical symptoms of a low thyroid. I must get it checked.

Dr.Davis,
   This post has convinced me that
your eventual protocol will be THE
standard MO in just a few short
years.Many thanks for your blog.

Now the question is, how to get a doctor to treat you for low thyroid function?  I went from doctor to doctor for a number of years complaining of most of the clinical symptoms of low thyroid.  Since my labs were "within the normal range", not one of them would prescribe any form of thyroid.

Finally, in desperation, I went to a "wellness" doctor who did put me on a trial of Armour thyroid.  MAGIC!  I suddenly had some energy, the gray clouds lifted, and I was finally able to begin to lose some weight... which eventually led to a 50 pound weight loss, which had been impossible before treatment.

Unfortunately, by then I had achieved a heart scan score which put me in the high 90th percentile for a 55 year old woman.  Thanks docs!!!

The average doctor out there seeing patients is still treating based solely on lab numbers, NOT on the (obvious) clinical symptoms sitting in front of them.  Such a patient is far more likely to be given a script for an antidepressant... I had plenty of doctors who were MORE than willing to write scripts for those!

I hope the TYP treatment protocol will eventually begin to make a dent in this situation.  I now know that years of untreated low thyroid certainly contributed to my high heart scan score.

Thank you, Dr. Davis, for Track Your Plaque!

Dr:

I have recently been reading your blog lately, and referring lots of readers from my own blog.

I'd be interested to get your "take" on this -- not diagnosis.

'Bout 18 months ago, I was at 230 (5'10) and looked awful. I was on Omeprezol for years for gastric reflux, a variety of prescription meds since early 20s for seasonal sinus allergies, culminating finally in the daily, year round squirts of Flonaise-esque sprays (the best for control without noticeable side-effects), and finally, Levothroid for about the last 7 years or so, as I had elevated TSH (around 9ish).

My BP was regularly 145-160 / 95-110.

I decided to get busy. I modified diet somewhat, cutting lots of junk carbs, and began working out -- brief, intense, heavy twice per week. BP began coming down immediately, such that within only a couple of weeks I was borderline rather than full blown high. Then after about six months, a year ago, I went to full blown low-carb, high fat, cutting out all grains, sugar, veg oils, etc, and replacing with animal fats, coconut, olive oil. You know the drill. Then, first of the year I felt great and simply stopped all meds, including the thyroid. I also began intermittent fasting, twice per week, and for a twist, I always do my weight lifting in some degree of fast, even as much as 30 hours.

That's when the weight really started pouring off. Take a look:

http://www.freetheanimal.com/root/2008/09/periodic-photo-progress-update.html

http://www.freetheanimal.com/root/2008/08/faceoff.html

In July I figured it's about time for a physical. Here's the lipid panel, demonstrating am HDL of 106 and Try of 47, great ratios all around:

http://www.freetheanimal.com/root/2008/07/lipid-pannel.html

However, my TSH was even higher -- 16ish. It seems odd that I was able to lose 40-50 pounds of fat (10-15 pounds of lean gain for a 30 pound net loss at that time -- now an additional 10 pounds net loss).

One disclosure is that I was drinking too much, almost daily, and quite a bit (gotta save some vices...). Anyway, I'm at the point now where I want to drill down. I know I need to see an endocrinologist and have T3 and T4 looked at, but in advance, I wanted to see if the recent changes I've made could make a difference:

1. Stopped all alcohol.
2. Stopped most dairy, except ghee and heavy cream, and cheese is now used as a "spice," i.e., tiny quantities -- no more milk.
3. 6,000 IU Vit D per day.
4. 3 grams salmon oil, 2 grams cod liver oil.
5. Vit K2 Menatetrenone (MK-4) -- side story: getting off grains reversed gum disease for which I have had two surgeries, then supplementing the K2 DISSOLVED calculus on my teeth within days -- hygienist and dentist are dumbfounded. Stephan (Whole Health Source), who comments here, has an amazing series on K2.

Well, that's about it. I'd be interested in your general take on this.

Stephan--

I suspect that there is indeed a connection.

I personally feel that wheat, for a variety of reasons, has NO place in the diet whatsoever.

I agree with anonymous. It is incredibly difficult to find a doctor who'll will diagnose and treat hypothyroid, whether mild or not. There are many people whose FT3 and FT4 levels are low (whether the lab considers them in range or not) yet their TSH is "normal" either because their pituitary gland has not responded to the situation yet or because the lab range for normal is outdated.

Many labs still use a TSH range of 0.3 - 5.0, when the American Association of Endocrinologists has recommended 3.5 be the upper limit, with many individual thyroid specialists pointing out that the healthy population's TSH readings have a mode of about 1.0 and a TSH of 2.0, or even 1.5 in older people, can be considered suspect when there are symptoms. And of course if someone has hypopituitarism the TSH range has no meaning at all.

So we have an unknown number of people in various stages of dysfunction because many doctors aren't knowledgeable about what the TSH reading means. Not to mention issues like T3 resistance. They are often misdiagnosed as having chronic fatigue, fibromyalgia, depression, and so on, or just told to go lose weight. I know personally of one lady who went to her doctor - she is overweight, 46, had the symptoms of early hypothyroid, and tested for high cholesterol and elevated blood sugar. The doctor told her she had diabetes and wanted her to begin metformin. Luckily, she went for a second opinion and low thyroid levels were found. She's feeling much better now with T4/T3 combo therapy.

There are also a lot of hypothyroid cases that aren't receiving adequate treatment. Some people receive relief with synthetic T4 replacement, some need a combination of T3 and T4, and others seem to need dessicated thyroid (eg Armour). Go to any thyroid support group and you will find people desperate for relief, their doctors are telling them their Synthroid is adequate, they must just be depressed or not eating well. Often the person will need to be treated for adrenal or pituitary function as well - as you have stated the hormones are all linked.

If anyone believes they are having thyroid problems, do your best to shop around for a doctor who believes in testing Free T3 and Free T4 thyroid hormones and treating based on symptoms not strict lab results. Doctors who are both traditional practitioners as well as having an interest in "holistic" or "alternative" medicine may be the best place to look. But be wary of alternative health practitioners who claim they can cure hypothyroid with diet or homeopathic remedies, etc. A certain diet free of goitrogens will certainly help support your recovery but treating your hormones is necessary.

R Nikoley,

Thank you so much for your efforts in promoting TYP at your informative health site! I've been keeping up with your blog posts and love your approach to optimal health and exercise regimens. Congrats with the incredible body recomposition shifts.  

Your experience with butter oil and vitamins ADEK2 are esp informative for me.

Your TG + HDLs ROCK!

I'm stopping/limiting alcohol as well -- I think the health benefits can be immense.

I have some questions for you:
--Have you considered getting a heartscan eval?
--Have you considered all the causes of Hashimoto's/HLA DR5 allele association? (it's an autoimmune disease just as HDL B27 is assoc with alkylosing spondylitis in many men; my sister had Grave's which is HDL DR 3 associated)
--Have you had the vitamin D level evaluted? goal 25(OH)D 60-80 ng/ml
--Have you had iodine testing? Deficiency leads to Hypothyroidism
--Have you considered the role of casein as a food allergen (subsequently triggering the immune system to continue to attack the thyroid gland -- effectively killing it off like Oklahoma bombings)? Cream has casein -- though minute enough to trigger autoimmunity reactions.
--Have you considered resumption of Levothroid or Armour Thyroid to control TSH to goal 1.0 to prevent further inflammatory responses?
--Other factors related to Hashimoto triggers are: stress, high cortisol, adrenal depletion, zinc deficiency, iodine deficiency, B-vitamin deficiencies,  vit ADEK deficiencies, food allergies (wheat barley rye corn/maize egg whites casein), heavy metal accumulation (mercury, lead, etc).

Hope that helps! I find it spectacular you cured your own gum disease.

-G

R Nikoley,

Thank you so much for your efforts in promoting TYP at your informative health site! I've been keeping up with your blog posts and love your approach to optimal health and exercise regimens. Congrats with the incredible body recomposition shifts.  

Your experience with butter oil and vitamins ADEK2 are esp informative for me.

Your TG + HDLs ROCK!

I'm stopping/limiting alcohol as well -- I think the health benefits can be immense.

I have some questions for you:
--Have you considered getting a heartscan eval?
--Have you considered all the causes of Hashimoto's/HLA DR5 allele association? (it's an autoimmune disease just as HDL B27 is assoc with alkylosing spondylitis in many men; my sister had Grave's which is HDL DR 3 associated)
--Have you had the vitamin D level evaluted? goal 25(OH)D 60-80 ng/ml
--Have you had iodine testing? Deficiency leads to Hypothyroidism
--Have you considered the role of casein as a food allergen (subsequently triggering the immune system to continue to attack the thyroid gland -- effectively killing it off like Oklahoma bombings)? Cream has casein -- though minute enough to trigger autoimmunity reactions.
--Have you considered resumption of Levothroid or Armour Thyroid to control TSH to goal 1.0 to prevent further inflammatory responses?
--Other factors related to Hashimoto triggers are: stress, high cortisol, adrenal depletion, zinc deficiency, iodine deficiency, B-vitamin deficiencies,  vit ADEK deficiencies, food allergies (wheat barley rye corn/maize egg whites casein), heavy metal accumulation (mercury, lead, etc).

Hope that helps! I find it spectacular you cured your own gum disease.

-G

Dr.Davis no where on your site do I see the importance of Vitamin C mentioned.Are you aware of the work of Linus Pauling concerning Vit C and the amino acid Lysine on calcification?
Paulibng summarised that subliminal Scurvy was to blame and the RDA for Vitamin C is far too low.
Ps. He did win a Nobel Prize for his research.
Many thanks for a very interesting and informative site.

http://www.vitamincfoundation.org/vitcheart.htm

Two things;

1. Dr. Davis, can you provide any evidence that supplementing D3 will decrease arterial calcification? From what I've read, increased D3 (especially absent K1 menaquinone/K2) leads to increased calcification. It seems quite likely that the low levels of 25D3 observed in people with heart disease may be due to overconversion to calcitriol rather than lack of intake.  

2. Anon wrote; "Dr.Davis no where on your site do I see the importance of Vitamin C mentioned."

Ascorbate uses the same transporter as glucose (sodium mediated, IIRC.) Most animals make ascorbate from glucose and if your blood sugar is high, your body won't absorb vitamin C. So while mild scurvy may very well be a component of diabetes, it's questionable how well increasing oral intake will fix that problem, if the nutrient is simply not absorbed.

I've come to believe my MANY health problems are hormone related but it's extremely difficult getting effectively tested and treated. I finally have some symptoms lessened by desiccated thyroid and am trying to sneak bioidentical low-dose estradiol, progesterone, DHEA past my migraine sensors. Hormones seem to be the most basic part of your system--if they could be in proper balance.

Dr. Davis,

Can someone have a good HbA1c but still have an undesirable amount of small particle LDL? ..Like perhaps someone with FHC that has their LDL particles floating around longer in the bloodstream and hence exposed longer to oxidants.

Thank you.

John M.

I love your blog but I have to clarify on this point. Check out the post by chris kresser: http://chriskresser.com/blog/why-hemoglobin-a1c-is-not-a-reliable-marker/

a1c is not reliable for many people because of the variation in RBC life length. healthy people's red blood cells may live as over 4 months whereas diabetic's live only as 60 days. This results in vast discrepancies.

For example my fasting BG averages 77 and postprandial peak is 85-90, but my hemoglobin A1c is 5.7

This doesn't make sense unless you account for differences in RBC lifetime.

I'm wondering what your opinion is of glycation and aging.

I've been reading that a major part of the aging process might be caused by glycation of proteins in the body, mostly caused by elevated blood sugar.

Do you believe that practically, one could expect a longer life expectancy to correlate with lower blood sugar levels?

The other day on the tv show, "The Doctors", they profiled a young woman concerned about her FBG.
She said that Diabetes ran in her family.
They did a bloodtest and announced that her FBG was 111.
The scary part was when they told her that reading was okay.
With that FBG, one can assume that everytime she eats, her post-prandial FBG is heading into dangerous territory.
But they told her not to worry.
She was right about her concern...as Diabetes will continue to run in her family.
Especially with that advice.

I found Walmart carries a Bayer at home A1c test kit that gives results in 5 minutes.  It came with two test cartridges so I was able to take one when I started lowcarb and another one 4 months later to see how much it came down.  (I came down from 8.3 to 5.2 in 4 months)

What is HbA1c for those long-lived okinawans with their rice-based diet, or those long-lived cretans with their wheat-based diet?

Wouldn't a lean healthy body (especially if there is occasional fasting) eventually clean up glycated and otherwise damaged proteins?

Glycation picks on the amino acid valine "wing" on the molecule of haemoglobin's B-chain portion. Aldehydes, both glucose aldehydes and non-glucose ones can become bound to that valine.

This can occur several ways. Glucose oxidation yields a byproduct, called gly-oxal; this is what most people monitor. In the glyco-lytic pathway called Embden-Meyerhof triose-phosphate drives gly-oxal into the molecule methyl-glyoxal (MG).

Type 1 diabetics have circulating methyl-glyoxal (MG) levels that are +/- 6 times greater normal. MG is a glycation end product.

Tyler's comment links to a discussion of fructosamine monitoring. This is from a non-enzyme driven reaction, called Amadori, where fructo-selysine and the fructos-amine 3 kinase cascade generates 3 De-oxy-glucos-ane (3DG); another glycation end product.

Enzymatic glycation occurs in pathological states. Macrophage activity spins off  the enzyme myelo-peroxidase; this generates hypo-chlorite. Hypo-chlorite pulls in the amino acid serine and then together they cause the formation of certain advanced glycation end-products; namely glyco-aldehyde and glycer-aldehyde.

Yet another non-enzyme chain of events can generate advanced glycation end products. This is when the molecule per-oxy-nitrite (ONOO-)gets stalled inside the cell and it induces the formation of gly-oxal/gluco-sone/aldehyde molecules that can contribute to glycation.

ONOO- normally is part of healthy cell signaling. When a metabolic processes is under sustained "stress" it (ONOO-) can't shift the cell function over to what it (the cell) needs to do (in order to adapt and cope). Instead of briefly signalling, signing off and going away ONOO-
lingers in the cell; a situation that may also be related to ageing.

I wonder if Dr. Davis can comment on situations where carb intake is reasonable and the patient has a decent HBA1c, yet still has higher than normal triglycerides and small LDL?

My own HBA1c has been in the 4.5-4.6 range, yet my trigs hover around 140-150, and I still have more small LDL than I'd like.

If restricting carbs doesn't work, D levels normalized, etc. what else could be the cause of higher than optimal triglycerides?

I know people with HBA1cs in the 5.4+ range, eat many more carbs than I do, yet still have lower trig numbers.

Hi Revelo,
Vitis vinifera leaf inhibits advanced glycation end product (AGE) formation. That is what many cultures, like Crete, eat wrapped around their cereal grain; we call it Grape Leaves in English (ex: stuffed grape leaves, a.k.a. Dolma in Greek).

Japan researchers (2009?) took 1 kilogram of dried grape leaves in 20 liters of water and stirred it for 3 hours at 80*Celcius. They administered the decoction in various dosages and found it can reduce the AGE of 3DG (3 de-oxy-gluco-sone) and also a marker of AGE in kidney disease, pentosidine, down to 1/5th the level from that study's AGE control levels.

The same study experimented with Anthemis nobilis using the same extraction technique detailed above. They propose the active ingredient responsible for the AGE inhibition is the compound called chamaemoliside.

Chamomile is the name of this plant in English; I suspect it is drunk as a tea in Crete. In the range of AGE inhibitors that they tested Chamomile was better acting than any other; grape leaves efficacy came in second.

Plants studied that inhibit AGE forming, in no particular order of effectiveness may interest you. These are: Crataegus oxyacantha (English = Hawthorn berry), Houttuynia cordata (English = Chameleon plant) and Astragalus membranaceous (English = Astragalus). Chameleon plant is a regular condiment used in Vietnamese and some south-east asian food; it smells kind of "fishy".

According to Steven Gundry MD, it is MEAT which is the primary cause of AGE's. (He doesn't cite any references for this in his "Diet Evolution" book.) He recommends Atkin's style low-carb/high-protein to lose weight, then low-fat (15% of calories from fat) as the maintenance diet. He is not too keen on grains, tubers or fruit, but rather emphasizes green vegetables.

Thanks for the nice explanations Might-o'chondri-AL

Diabetic nephro-pathy (ie: kidney complication), and kidney disease have elevated AGE. These are monitored as pento-sidine, gly-oxal, methyl-gly-oxal and 3 de-oxy-gluco-sane; which the body tries to excrete as carbonyly compounds.

Carbonyl compounds are hard to get through the kidney filters and cause an increase in uric uremia, which can be toxic. Too many carbonyls can cause, the so called, "carbonyl stress" of diabetic nephro-pathy.

Diabetic patients' kidneys eventually can't excrete enough sodium (Na); and that contributes to the high blood pressure (hyper-tension) diabetics tend to suffer from.

Ketones merit mentioning too. One of the markers for AGE in the kidneys is N-carb-oxy-ethl-lysine; which may (or may not) be a side effect of ketones. Type 1 diabetics do show elevated ketone levels incidently.

I am not able to offer any perspective on ketogenic diets and AGE however. However, vitamin C is known to decrease ketone bodies. (In the previous post, "Battery acid ...", more
diabetic responses to vitamin C appears among the comments.)

I've been eating low-carb (basically paleo) for the last 4-5 mo and just got my lipid panel results.  They sky-rocketed.

Cholesterol 300
  
Triglyceride 150  
    
HDL          33
    
LDL             237


Every number got worse.  The part that really sucks, is that the diet makes me feel great and nearly all my body fat is gone.  I'm 37, 5'11, 180 lbs and probably about 9% body fat.  Now I'm wondering what kind of trade-off I'm making.  Any thoughts, doc?

Testing different foods one hour after meals, it seems like a good rule of thumb for me is that each ounce of carbs raises my blood sugar about 10 mg,and that the kind of carb doesn't matter nearly as much as the quantity.

Paradoxical low carb yet relatively high HbA1c & higher carb but relatively lower HbA1c is reported by Annon. Doc assuredly deals with cases like these and has to resolve their enigma one by one.  

The gene HFE (human hemochromatosis protein, nicknamed High Fe  where iron = Fe)can have a variation (reference code = HFE rs1800562). This variation is seen in +/- 5% of Caucasians, but is not found in East Asian nor African genes.

More hemoglobin is in circulation for those having this HFE genetic variation. In this case, the same amount of blood sugar that can contribute to glycation of hemoglobin has more hemoglobin surfaces to glycate. Think of it as the glycation has to spread itself thin; the dilution of it's effect makes the % of Hb1Ac less (ie: lower Hb1Ac % measured in the blood sample).

On the other hand, genetic variation rs855791 of the gene TMPRSS6 (trans-membrane protease, serine 6)is implicated in anemia. In these individuals Hb1Ac readings range higher; there is less hemoglobin relative to the glycation potential in their blood stream. Think of it as the relatively low proportion of hemoglobin which has to bear all the glycation burden
(ie: Hb1Ac % is higher in their blood sample).

Anemic (hemolytic) tendency is also driven by variation of gene HK1 (hexo-kinase 1). This enzyme modulates how glucose inside the cell goes through  it's processing pathways.

This gene (HK1) codes for the unique iso-form of erythrocytes; erythrocyte configuration can figure in to low hemoglobin. In other words it is also a factor in high Hb1Ac readings; glycation potential in the blood over burdens the limited amount of hemoglobin around.

In response to several questions about the potential disconnect between small LDL/triglycerides and HbA1c: Yes, there are people in which one measure is more resistant. It varies based on the mix of underlying genetic predispositions, so it's hard to generalize.


Might-o'-chondri-AL--

Great discussion. Thanks, as always. You bring an incredibly sophisticated perspective!

Jonathan--

Spectacular! And within an unusually brief timeline for HbA1c.


Revelo--

Might-o'chondri-AL is referring to endogenous glycation. You are citing a discussion about exogenous glycation, two separate phenomena.

Might Jenny's observation and Nigel's study reference be reconciled somewhat ? I'll tag on my disclaimer of being unqualified to judge low carb or specific diets; since I've never struggled with weight or diabetes, and am not a doctor.

The study Nigel linked was done with all Kuwaiti subjects. In that country co-sanguinity in marriage is practised by +/- 54.3 % of Kuwaitis. And 1 in 5 are reported to be diabetic.

The data is very admirable; my suggestion is that the data trend may not exactly transfer to a modern Caucasian population; which is essentially interbred from migration and war (rape). This may be why Jenny sees a +/- 6 month plateau among her respondents and the co-sanguine Kuwaitis saw changes continue for a year +.

Genetic poly-morphisms influence fasting glucose (GCK, G6PC2 and MTNR1B), are implicated in Hb1Ac, triglyceride levels, HDL levels & so on. That said, I personally would try the low carb approach if I was diabetic.

oops posted this in wrong thread

Re: Anonymous with Cholesterol 300,  Triglycerides 150,  HDL 33 ...

Suggest you try a technique many dieabetics find helpful to understand food consumption influence on their blood sugar profile,"eating to your meter".
For a few days, record your blood sugar level immediately before eating a "normal" meal, and then after the meal get 1-hour and 2-hour post-meal blood sugar readings. Separate meals by at least 4 hours. Concentrate on monitoring your main meals and ignore snacking for the first go around. Better however, if you can actually avoid all snaking during period of the testing. Also you will want to add to your journal the foods, ammount consumed, and time it was consumed. If post-meal blood sugar values are high, then to determine a pattern folllowing a meal do a series of hourly post-meal readings until you reach 85 mg/dL or so. As a graph, these results should be helpful to you. Expect that the results will be revealing to you with unexpected high blood sugar values even after following a paleo diet. And if so, it does mean that paleo is not for you, only that you need to more discriminating in what and how much you actually consume.

I would be interested in hearing about your findings. By the way, you did not mention the blood glucose or HbA1c results of your recent lab tests.

My regards and good luck ... spo

BTW: practice good technique with the finger sticks. Do a quick but good hand wash using soap and a warm water rinse prior to a stick. Dry hands well. Dont squeeze hard at the site to encourage blood flow. The original stick should be sufficent to raise a drop of blood for the test strip. Using alcohol swabs and changing out lancets is not necessry when only working on youtself. Keep the test strip vial tightly closed other then when removing the current test strip. If you encounter an "extreme" value, retest for confirmation but clean hands again prior to the retest. My experiences regarding unexpected readings seems to usually invovle hand and finger contamination of some form.

Finally, on Amazon.com I am able to purchase unexpired test strips in 50 strip lots for my old AcuCheK Confort Curve meter for less than $0.16 or so a strip and often with free shipping. You just have to broswe around a bit.

@ Anonymous with 300 TC
I would say it could possibly be your liver cleaning itself out (it could have been getting fatty).  The higher Trig might be a sign you are getting too many carbs from somewhere (at least till your sugar stores empty some and insulin sensitivity goes back up) but it could be the liver cleaning out as well.  I think HyperLipid posted something about this once.

What puzzles me is why the Japanese who eat their high glycemic diet (rice and more rice) have such low rates of heart disease and diabetes and live a lot longer than we do.

Dr. Davis,

Be wary of the Glycemic Index. It has been promoted very heavily by the grain companies as a way of confusing the public that their products are healthy.

The Glycemic Index values are established by testing foods in completely normal people. Anyone who has abnormal glucose tolerance (i.e. prediabetes) is likely to have a very different reaction to a supposedly low GI food than a normal person.

Oatmeal, for example, can give devastatingly high readings to someone with pre-diabetes, though it is supposedly low GI. Whole wheat bread was proven to raise blood sugars just as high as white bread in people with diabetes in a recent study.

People will have much better results if they ignore the Glycemic Index and pay attention to the total carbohydrate count of a serving of the food they eat.

Every gram of that carbohydrate will require the same amount of insulin to be processed. If it is done slowly, you might not see a high blood sugar, but you will have elevated insulin, which will worsen weight gain and other symptoms of metabolic syndrome.

You might find it interesting to research the extent to which the grain industry has been promoting the GI concept. I get quite a lot of fancy spam from PR firms working for organizations with names like "the Whole Grain Council" telling me how healthy low GI foods--like their grains--are for people with diabetes.

They aren't.

Don't forget that sucrose is the one-two punch of damaging foods.  Half of it is glucose, a.k.a. blood sugar and the cause of the glycemic index/glycemic load values.  The other half is fructose, which causes your liver to immediately stop whatever it is doing and create triglycerides that directly raise your serum triglyceride number.  As in, one of the two numbers in the typical cholesterol test that actually means something (and means high risk).

Sucrose creates the fats (triglycerides) in your blood and then guarantees that they make you fat through insulin's action that pushes triglycerides across liposome (fat cell) cell walls.

It's especially important not to be fooled into thinking that GI and GL are the whole story of why sugar is bad for you.  Otherwise, you end up believing silly assertions like, "White grape juice is better for you than HFCS because white grape juice has a lower GI."  White grape juice is 80% fructose, so of course it has a lower GI than HFCS which is 55% fructose.  Doesn't make it any better for you.  It's just bad for you in a different way.

This quote is right on the money, except for one detail. The author assumed corporations are against regulation, when in fact they love it and depend on it.

What keeps drug companies in business? FDA approval requirements. What did food companies push for in Canada? Total ban on "low-carb" labelling.

So the response to greed and corporatism is not regulation but a free marketplace where everyone is allowed to compete, big or small.

Keep up the good work.

Perhaps governments should do better regulating food publicity and food labeling. For example, in the US they're trying to implement a system called "NuVal(tm) Nutritional Scoring System". Anyone here knows how it works? The official website is http://www.onqi.org and there are 2 articles about this at http://www.reuters.com/article/domesticNews/idUSN2750793620071128 and http://www.nutraceuticalsworld.com/articles/2008/07/online-exclusive-nuval-nutritional-scoring-system On the other hand, if this ONQI numerical algorithm incorporates the recommendations of the "famous" USDA Food Pyramid, and ignores evolutionary nutrition (paleodiet, which was low-carb, low insulin, no grains or dairy, etc.), it will certainly be of little use.

Regarding the glycemic index and sugar control, I wonder how useful would it be to get hA1c tested in most people with heart disease?

Wouldn't it be a good gauge of glycemic control? I wonder if l it could play a role in Dr. Davis' program... Besides checking just lipid parameters, perhaps those with lower hA1c would also have less plaque?
And it should be useful to the patient too, so they can see how well they have been eating over the past several months.

The GL (Glycemic Load) is a much better everyday tool to use than GI (Glycemc Index) and here's why: The GI number doesn't account for portion size.  So a drop of glucose and a cup of glucose both have a GI of 100 (it is the reference sugar, so it has the highest rating).  Obviously the former isn't going to do much to your insulin response, and the latter is going to be devastating.  Glycemic Load takes into account portion size.  It is a real-world application of the Glycemic Index.

Once you know this, you realize that the published Glycemic Load number of any food can be miraculously halved...by eating half of it.  (Of course, you can also double it by eating a double portion!)  It puts the whole concept into practice in a tangible, useable way.

Nutritiondata.com uses the GL exclusively and I highly recommend their site.

I used to think the government should do a lot of regulating, because the corporate interests don't do a good job of self regulation.  Not so sure about government regulation now.  They gotten so much wrong, it's frightening.  

With so much of our increasingly complicated lives involving things of which we have little common knowledge anymore (how our food is produced, what to do to optimize health and avoid illness, what chemicals are hazardous long-term, how to do even simple maintenance on our belongings, etc.), it is hard to be personably knowledgeable enough about everything, so it is easier to pass most of it on to the regulators and hope for the best.  But wow, that's a massive gamble that we don't seem to be winning very often.

Japanese who lives as long as 90++ years eats their rice at the end of their meals...

The example of Kitavans and also having seen our Kerala people, it makes sense to totally disregard the GI or GL indexes. What is probably more important is the harmful lectin content of grains/legumes.

If we could simply stop eating all grains/legumes and add nourishment that is missing because of our lack of sunlight (Vitamin D3) and lack of good quality meat (Vitamin K2 and Omega3), and possibly other lacking nutrients in our diet, we could also be healthy.

I believe that a high GI carb is actually equivalent to saturated fat, because it will become one after the action of Insulin. Of-course this does not apply to diabetic and may not apply to people with low D3/K2.

The low GI is probably not as good because it will give glucose for a long time and will make the glucose level high for a long time.

For people like me who have already got leptin resistance cannot possibly avoid the glucose overload if they have to keep their fat mass below the level were our brain feels the leptin. The brain thinks that there is no fat at all to convert to glucose and the low blood sugar makes us feel dizzy.

I think that obesity is caused by WGA and similar lectins that cause leptin resistance, compounded by the fact that we don't have D3/K2 which could fight against these ailments.

I think White Rice is the only grain that has very little lectin and can be consumed easily. The south Indians mix it with sprouted legumes and grind it then ferment it before cooking it. This whole process effectively destroys the lectins almost completely. This is probably the only safe way to consume our legumes. Wheat etc the high lectin grains are poison for our health.

-anand

All of the above foods with GI's and GL's that match or exceed that of table sugar are made of wheat and cornstarch. Some, like Shredded Wheat cereal and rice cakes, don't even have any added sugar

But, can't we get ample vit.D3 from sun exposure? I'm nursing my second infant, and rather than supplemetning her with vit D, since breastmilk doesn't contain vit d, I expose her to sunlight often, for a few minutes at a time to prevent rickets. Why does anyone need vit D supplements in our food etc when it can be gotten for free in the sun?

Less than 1 in 20 people have sufficient vitamin D blood levels when they are checked in Wisconsin and other northern climates. Studies suggest that between 30-50% are deficient in southern or tropical climates, such as Florida and Hawaii. There are many racial and other reasons for this, but mostly it has to do with wearing clothes and living indoors. The only way to be certain is to have a blood level checked.

Soundhunter...breastmilk isn't deficient in vitamin d per se, it's deficient if the mother is deficient - so it's important you consume enough vitamin d in your diet (or supplements) and/or get enough exposure to sunlight.  One good source in the winter months is cod liver oil....vitamin d is also found in natural cheeses (with higher amounts in grass-fed, alpine cheese), eggs (in the yolk) and tuna in oil (as well as other fatty fish).

And what happen with people who are allergic to lactose there are substitutes for that?Generic Viagra  Buy Viagra

You'll note that the only naturally-occurring food sources of vitamin D are the modest quantities in fish, egg yolks, and liver. All the other vitamin D-containing foods like cereal, milk, and other dairy products have vitamin D only because humans add it.

How about acupuncture and chinese medicine? Anecdotally, they will be able to help you through monitored use of chinese herbs and acupuncture.

I'd also like to add that if one can't get good thyroid care inside an HMO network or "universal" healthcare system, it can be money well spent to go "outside" the system  for private care.  Granted, paying for non-reimbursable care isn't cheap and one has to do a lot of investigating to make sure one isn't paying for more of the same inadequate care (or worse care).  But I think too many people who can afford to pay for private care suffer needlessly by doggedly sticking to inadequate care because alternatives cause a financial dent.  But in the long run, if one can find good care even though there is added expense, it can save a tremendous amount of suffering, as well as saving money.

When I was seeing a thyroid doc out of my HMO network, I was still able to get my lab work done by the HMO approved lab  and covered by my HMO insurance (the lab faxed the results to the out-of state doc without question), though the results did go into the computerized file at my HMO network, so was visible to any HMO doc.  And my HMO insurance Rx plan covered the conventional meds prescribed by the out-of-network doc without question (but not the compounded Rx).  Yes, it cost me a few hundred dollars a year to see the doc once year, a few telephone consults, and the non-covered compounded Rx, but it well worth it.  I was finally feeling and functioning better.

And when I went back to my HMO eventually (mostly because of travel scheduling difficulties in seeing the out-of-state doc), I was in a better position to make a case for similar care with the HMO endo (I told him flat out I'd had trouble getting good thyroid care from primary care physicians in the HMO and so went "private" for a couple years, but wanted to find someone local in the HMO for convenience) .  He doesn't do compounded Rx, and typically prescribes only Synthroid, but he accepted that I prefered T3 with the T4 (and he "accepted" the "odd" way I adjust my T4 dose with different amounts of 50 mcg Levoxyl on different days to get an overall weekly dose that works - the 50 mcg tablet has no dyes added and he accepted that I preferred Levoxyl over Synthroid).  So for the first time with the HMO system, I feel my thyroid care is more of a team effort that includes my input, instead of being at the mercy of whatever is dished out to me.  And if the situation changes, I will promptly go outside the HMO again.

I would also suggest using the Armour site to look for prescriber's.  Their site has a little 'doctor finder' feature.

It doesn't mean they'll necessarily treat you, but they tend to be more open-minded that doctors who prescribe Synthroid only.

Most doctors won't use body temperature as a guide, by the way. And most won't treat Hashimoto's unless your TSH is >5. I know it's wrong, but that's how it is.

Supplementing iodine may be helpful, unless you do have Hashimoto's, then it could make it worse (so you know). But you won't know you have Hashimoto's until you get your thyroid antibodies tested.

A couple of other suggestions:

Ask your doctor for Free T3/T4 AND thyroid antibodies. If your TSH >3 and your anitbodies are high, it really improves your odds of getting treatment. Many doctors ignore antibodies, but some do pay attention to them.

If your TSH or antibodies are high at all, ask your doctor for a thyroid ultrasound. If the ultrasound is abnormal at all, it improves your odds of getting treatment too.

Just going to a doctor with a TSH of 1.5-2.0 and normal T3/T4, it'd probably be close to impossible to get treatment. It really helps if you have the antibodies or ultrasound or something else to show the doctor.

No person should break the law.

However, there might be people within the arctic circle who don't have easy access to a physician who is willing to prescribe natural thyroid, including armour thyroid.

What to do in a situation like that?

One solution:  Find a site on the internet that provides for ordering and shipping thyroid, including Armour Thyroid, without a prescription.  There is at least one site that can be found via google that will do this.

Warning:  There are significant dangers in supplementing thyroid without being under a doctors care.

Thanks, Anna.

Regarding the thyroid issues Dr. Davis has been commenting on lately, and wondering why it seems so prevalent, have you considered the possibility that diet is playing a role.

And when I say diet, it's probably not in the way you think --

Carbohydrate restriction can lower thyroid hormone output, especially conversion of T4 to T3. Those who practice caloric restriction tend to have lower levels of T3 too.

If Dr. Davis is seeing somewhat low, but still in 'normal' range T3/T4, with perhaps sluggish T3 levels, in patients AFTER they change to a no wheat, low carb diet, perhaps that is the reason why? Or perhaps that's why Dr. Davis' own thyroid had somewhat sluggish numbers?

But if people all have high thyroid antibodies too, or all have crummy thyroid levels while eating tons of carbs, that wouldn't be a reason then.

Just throwing that out there to think about.

for those who are willing to do the research and check their tsh levels then ordering online is an option. start with a low dose 15 to 30 grains and then ck your tsh. Increase dose to normnal tsh levels.  There are multiple sites for armour and synthoid that do not require a prescription. When you take this road to self medication you must realize you are toally responsible for your actions and well being. Be sure you know what you are doing
Don

Lately I've been giving a lot of thought to the LC packaged foods that many people turn to when they first embark on a LC diet, such as low carb breads, crackers, etc.  For me, it was LC pita bread a few years ago, before I essentially went grain-free.  These products, in addition to usually having a lot of soy in them, also have added wheat gluten, to reduce the starch and boost the protein content.  Low carb they are, and generally will help with the BG control and overall weight reduction or maintenance.

Both gluten-containing and soy foods are relatively new foods to the human diet (only consumed since the age of agriculture) and modern industrial processing bypasses many of the steps that earlier humans took to render them safer to consume.  Soy can be a powerful thyroid inhibitor (goitrogen)  and gluten can trigger an auto-immune response in susceptible people (genetic predisposition to gluten sensitivity is much more common than previously thought, though how widespread is subject to debate).  There does seem to be a strong connection to autoimmune thyroid conditions and issues with gluten.

So people who eat a lot of soy and gluten-enhanced LC foods might be literally be shooting themselves in the thyroid, especially those who overconsume  consume them (dieters don't ever become overzealous, do they?  ), instead of foods that are naturally low carb and/or have a longer history in the human diet.

I think ordering prescription medication over the internet from a less than reputable pharmacy, without a prescription, is a real bad idea. And if they don't require a prescription, that pretty much automatically makes them less than reputable.

And don't assume thyroid medications are completely benign. They can have side effects too.
And especially in patients with heart disease. You have to be titrated slowly and need to be under a doctor's care.

DIY Armour/NTH treatments can be troublesome. If you are suffering from adrenal fatigue, starting immediately on thyroid replacement can cause heart palpitations and other symptoms of physical and mental anxiety. If you have low cortisol and DHEA (they invariably go together), you will probably need to take a low-dose steroid and/or DHEA replacement for a month before beginning thyroid. It is best to get these things tested first, even if you have to do it on your own. I think the Stop The Thyroid Madness author has put together some lab test packages for people to get the right things tested. And when you're taking the replacement steroids and hormones, you need to keep monitoring your levels every month at first, then every three-four months once you stabilise.

Google for the "Top Thyroid Docs" list by Mary Shomon for sympathetic doctor suggestions/review.

I forgot to add, the thyroid books by Dr Broda Barnes are good reading, easy to understand if you're a layman too. He had one on incidence of heart disease in patients with corrected thyroid function which is very interesting. I don't recall he mentioned wheat, but he certainly believed that we should eat good old saturated fats like butter, lard, coconut, etc, to support good health and thyroid.

Anecdotally along with the iodine I've heard a brazil nut per day suggested for the selenium. Where I live is not selenium deficient, thanks to the end of the Ice Age glaciation: this is reputed to be one reason for the longevity here. Next time I catch a doctor I'll ask if there's much thyroid disease here (they will diagnose and treat here, my TSH was 0.99 so something is working!)

That iodine dose may still be too low. Remember the RDA was set at a level just to prevent goiter, not for optimal health. Check out www.breastcancerchoices.org.
Healthy Japanese get 12.5mg (12500 mcg) of iodine per day. Probably we are all low in iodine and bromine competes for binding sites. Bromine is ubiquitous in our chemically laden environment and is used as a dough conditioner by commercial bakeries---they used to use iodine. The thyroid gets the bulk of our low iodine but it turns out that iodine is also concentrated in our gonads, adrenals and especially the breasts. Our epidemic of breast cancer and fibrocystic disease may be due to iodine deficiency.

If you cannot get this treatment on HMO, then you should look at going private. Believe me, it is not something that you can ignore

Dr. Davis,

I realize that you aren't in the business of diagnosing ailments or conditions via the internet, but I've recently experienced some hypothyroidism symptoms (low body temp. average of 96.7, fatigue, weight gain, hair loss, etc..) that my Doctor insists are unrelated to the disease.  In addition, he has also just put me on a combination of Crestor and Trilipix for an abnormally high triglyceride reading, despite this reading being a one-time fluke.

My labs are as follows:
TSH:       2.761
Thyroxine (T4): 6.4

He was not interested in doing any more thyroid testing beyond these two.

Lipids:
Total Cholesterol: 165
Triglycerides:     415
HDL:               22
LDL:               N/A

After a week on the Crestor (10mg) / Trilipx (135mg) combo, I was stricken with muscle aches and pains, tinnitus, popping ears, dizziness and a foggy out-of-it feeling.  After two weeks and finding your site, I discontinued the use of the two cholesterol medications against the Doctor's advice.  I've since starting taking an Omega 3-6-9 supplement three times daily along with my daily multi-vitamin.  I also take diazide/HCTZ for slightly elevated BP (130/96) and have recently begun following a strick low-carb diet and exercise routine.

Again, I don't expect a diagnosis from you, but would appreciate if if you could voice your thoughts on the viability of me continuing to find a doctor willing to be more open minded to thyroid issues as well as pursuing more natural remedies to lipid issues.  

Thanks for providing such a valuable resource for those of us who are getting fed up with the flawed standard of care that is currently being forced on so many people.



My labs show the following.

I agree on the iodine dose question.

The difficulty comes in trying to generate conversation through the blog for people who may or may not, for instance, have underlying Hashimoto's thyroiditis or thyroid nodules, in which case taking higher doses of iodine can trigger extreme excesses of thyroid hormone.

I had been on Sythyroid for a few years but no one had ever mentioned or tested for Hashimoto's. Still feeling horrible, I found a holistic MD, and was diagnosed with Hashimoto's and started on Armour.
Do I still have Hashimoto's or is it quiet now that I am taking a different hormone?
The holistic said it would "kill" my thyroid and move on to another area, like adrenals.
I did have a positive ANA for many years and tested for Lupus, RA, etc. many times. Then routine testing showed my ANA had returned to normal values.  
Any ideas because my current endo. sure isn't forthcoming with any and doesn't/hasn't tested for antibodies.  He feels I am just hypothyroid.
I appreciate all your information!

To test for Hashimoto's you need your TPO and TGAB antibodies tested. If they are above normal range, you probably have it. The definitive diagnosis is via a biopsy, but without a nodule that isn't usually done. An ultrasound is another diagnostic tool -- if your thyroid looks enlarged, nodular or all lumpy, along with antibodies, it's pretty safe to say you have Hashimoto's.

I have never read, or heard of, Hashimoto's 'attacking' other organs after your thyroid is burnt out. That theory seems a bit out there to me.

Antibodies can fluctuate, and with thyroid hormones usually become lower over time.  Inflammation tends to be reduces with hormones too.

OK I caught one of our GPs yesterday, the selenium in the soil connection appears to be a non-starter. Her experience was that she found hypothyroid "quite often" predominantly in post-menopausal women and with incidence increasing with age. It's impossible to compare numbers with other areas since they actively look for the condition here and don't elsewhere. Also we have a lot of local longevity so more patients with systems wearing out purely through ageing.

I always wonder about something I hear frequently - the issue of "soil mineral depletion".  Not that it isn't possible, but how significant is this and how widespread?  People don't generally eat "locally" produced food anymore; food supplies are distributed from all over the globe now, though agriculture is quite intense in some places, like the Central Valley of California, or cornfield in Iowa.  Wouldn't the shipping of food products all over sort of "average out" the minerals like iodine and selenium?  Or are  all the major agricultural regions of the world growing with depleted soil propped up with little more than NPK replacement?  

I'm actually more into local, seasonal organic food than worldwide food.  LIving near the coast, presumably there is adequate iodine in the soil, but here I am, hypothyroid anyway.  Just wondering...

Hard to tell about the soil mineral depletion thing, there are major regional variations which can show in animal diseases and require supplementation, salt licks etc. as well as human disease clusters. Deficiencies can show before "deficiency diseases"

I trialled several different supplements but none of them made any discernible difference, probably a widely varying diet helps, plus fish, and local farmers who use high levels of organic manure and feed the soil as a whole rather than (increasingly expensive) stuff out of a bag and treat the soil as a sterile growing medium. Grass-fed rather than grain-fed meat, and game, probably helps too in picking up trace elements

The downside of World Trade may be that while you get more trace elements from crops from different regions you are probably also getting more pesticides some of which are banned in the West

I've been doing so great after taking 1 1/2 gr nature-Throid brand of thyroid since october 08 and stopping all statins. Taking the Now D-3 at 5,000 per softgel. Now if I can just get back in the forums again....LOL   Dennis  still no 4th heart attack since 12/04

I wish my family doctor was open to new things. I asked him about Armour thyroid he said that he has hundreds of patients on Synthroid with no problems and I don't want to start a new prescription without my family doctor knowing about it. I'm on 75mcg of Synthroid and would really like to try Armour thyroid...might have to wait until he retires (could be soon) before I see if I can get Armour..

What about supplementation with tyrosine along side the iodine? Tyrosine is a precursor to thyroxine, and there have been a few interesting studies, like this one:

Psychoneuroendocrine effects of combined thyroxine and triiodothyronine versus tyrosine during prolonged Antarctic residence. Sure, the tyrosine may be working indirectly (going into neurotransmitters more than thyroxine) ... but at the end of a day, it seems to reduce TSH by about a third, while raising free T3 by 6%, while improving mood.

Dr. Brownstein (Family physician, holistic doc in Michigan) in his book, "Iodine, Why You need it, Why You can't live without it" makes an interesting case for temporarily increased TSH (5-30mU/L higher) after correcting iodine deficiency.

In addition to just stimulating thyroid hormone production, TSH also increases the production of the iodine transport cells (NIS). Without more NIS available, iodine couldn't enter the cells and be utilized. Therefore, increased TSH makes sense during the initial phase of iodine correction.

As one increases their iodine consumption, they could experience this increase in TSH for as long as several months. As long as the T3 and T4 levels are normal, then the TSH elevation probably isn't a sign of hypothyroidism.

If you haven't yet read this book, it's worth the 2 hours it took me to get through it.

I guess it could be said that a flaw some have is a willingness to take advantage of the uneducated.  

On the niacin, my guess is that the over the counter Slo Niacin is manufactured by the same company in the same facility as the prescription form.  The machines used would be different as the FDA wants this, but the manufacturing procedures and source product would be the same.  I don't know this for a fact, but it would not surprise me if it were true.  

For fish oil, there are only a couple facilities in the world that manufacture fish oil.  The products these facilities sell are pretty much all the same in quality.  Everyone buys from the same places.  The facilities that encapsulate pharmaceuticals often times also manufacture health foods in the same plant.  The exact machines used for encapsulating pharmaceutical fish oil and store shelf fish oil will need to be different for government purposes but basic manufacturing practices followed will be about the same.

I was in a unique situation to witness a Germany company sell a product as a health food - and at the same time was going through the FDA drug approval process with the same exact patent protected product.  The product never did make it through testing in the end.  Phase 3 (I think that is what it is called) human studies at the Cleveland Clinic were a bust as too many people stopped taking the product. (Reportedly the product worked so well that people stopped taking it as they felt healed.)  I remember the German company planned to make “large” amounts of money off of their product if it passed testing as they would be able to charge a premium.  After testing fell through they decided to not try again.  A large American firm took on their product and placed it into every store in America, - and that was good enough for them.

http://www.ajcn.org/cgi/content/abstract/84/4/694
The case against ergocalciferol (vitamin D2) as a vitamin supplement provides more information which may interest some.
http://www.ajcn.org/cgi/content/full/85/1/6
Risk Assessment for Vitamin D shows that up to 10,000iu daily produces no observable adverse events but readers should note that actual harm occurs is 40,000iu are consumed daily.
However as you body uses only 4000iu daily http://www.ajcn.org/cgi/content/full/77/1/204 there has to be good reason to take more than 4000iu daily.

Dear Dr. Davis,

I've been reading your blog for sometime, since I found the link on Regina Wilshire's blog. I've learned a lot and want to thank you for sharing your insights and expertise with everyone. I imagine (and hope) that there are many, many more people reading it than are posting. I think what you and your colleagues are doing with Track Your Plaque is phenomenal. Interesting that there seem to be none of these services in New England, that bastion of tradition.

I've been fascinated by your articles on Vitamin D.  In looking around at Vitamin D3 (cholecalciferol) to purchase online (I can't find gelcaps locally), I came across the "Wilderness Family Naturals" web site.  In their article on cod liver oil ( http://www.wildernessfamilynaturals.com/cod-liver-oil-health-benefits.htm ), they state:
"Cholecalciferol is the form found in vitamin supplements and fortified dairy products and not the hormonal form of vitamin D, namely 1,25-dihydroxycholecalciferol."
The also state: "The form of vitamin D that we get from supplements is not fully active."

Can you talk about this for us?

In any case, my question is: can't I just take my cod liver oil to get my Vitamin D? Do I need the gelcaps of D3 in addition?

Thanks again,
Barbara

Wow! Thanks for the helpful commentary.

Barbara-
It's really very simple once you start checking blood levels on everybody--you quickly begin to learn what works and what doesn't.

Vitamin D3 (cholecalciferol) is what you need. Don't be confused by the comment about the "real" form, 1,25-diOH-vitamin D3. This is a kidney metabolite. We all still need vitamin D3.

It's best to find D3, not cod liver oil. I remain skeptical about the safety of cod liver oil due to some reports of preparations with excessive pesticide residues.

Try www.vitaminshoppe.com or look for Carlson's preparation, both 2000 unit gelcaps of D3.

I take D3 and have been for at least 3 months. I've been taking 3000iu/day and just had a blood test that indicates my blood level is only 33 (22 - 67 is the reference level).

I'm out in the sun at least 15 min a day, not including driving, walking to and from, etc.

So...how much Vit D should I be taking? I believe you recommend a level of 50-60?

Cindy--
We commonly use 5000-6000 when situations like this arise and generate desirable levels. Also, the values of "normal" in the reference range you provide suggests that your laboratory also runs an outdated method of measurement. (The newer methods tend to show "references ranges" of 20-100, or something close to that range.)

Thanks!! I've made several changes recently thanks to your posts!!

Hi Dr. Davis,
I see both Vitamin D and Vitamin D3 supplements being sold:

Vitamin D

Do I need to assume that supplements labeled as simply Vitamin D are, in fact, D2?  Are there other forms that it could be?
Thanks,
Mike

Mike-
No, you can not assume D is D3.

Always look for:
1) gelcaps, not tablets
2) D3 or cholecalciferol
3) Never D2 or ergocalciferol.

Those little attentions to detail will help a bunch and ensure you get the right stuff.

Thanks!

I was diagnosed with a defiency in vitamin D in january . My total level was 12ng/mL . I started taking supplementation, 800 IU daily of Vitamin D3 (cholcalciferul), and a Centrum multi-vitamin which has another 400 IU . I took that for over 6 months. I just had my level checked again . It is only 15ng/mL still !
How much D3 should I be taking ?
And what would be a good target for a 31 year old male ?

There's no "one-size"fits-all" in dose for vitamin D. However:

1) The vitamin D in multivitamins doesn't work at all.

2) You're therefore taking 800 units per day, the dose for a small child.

3) Most adults require 2000-6000 units per day. The D must be in capsule form, not tablet.

4) In the Track Your Plaque program, we aim for a blood level of 50 ng/ml.

Thanks, Dr.

1) Can you expand on why that is re. multi-vitamins inefficacy of vitamin D ? Does this apply only to the vitamin D in them ?
Are the liquid forms of multi-vitamins any better than the tablets (eg. centrum liquid) ?

2-3) I thought according to the FDA, the recommended daily dose was 400 IU for an adult and the safe dose was 2000 IU. How did you come up with your numbers ?

3) You guessed it - I had been taking Vitamin D in tablet form only. I can certainly believe that they were not effective given my test results. But can you explain why the tablet forms don't work ?

Tonight I looked for vitamin D in liquid form . I had to go to 4 places - Costco, my Kaiser pharmacy, Longs, and finally Walgreen's, which had some softgels from fish oil. I bought 100 softgels of 1000 IU each for $7.99.

The tablets I have are Nature made brand. I have about 300 left. As far as tablets go, how do you rate them ? Would you just throw them away and just take the gels ? Or take some gels and tabs ? I hate to just waste the tabs.

4) Thanks !

Please refer to the several previous posts under "Vitamin D" or our extensive discussion on the www.trackyourplaque.com website.

Vitamin D should always be either "D3" or cholecalciferol, NEVER "D2" or ergocalciferol, since D2 exerts negligible benefits.

If your preparation fails to specify which form, look for another that does.

Hello I'm a vegan from Germany and like to respond to the argument that is circling through the web relating to D2. Since I'm vegan don't use D3 since that is produced by irridating butchers-wool with UV-light, an information that is often left out when touting this version of vitamin D as the "natural" one. Because of all the negative rap D2 has gotten, it has now in fact disappeared as a supplement in the EU, effectively starving vegans and other vegetarians of vitamin D. I was thus forced to look for alternatives to have my winter supply of vitamin D. What I do is grow my own delicatessen mushrooms right here at home and either dry them in the sun or irridate them with the Utra Vitalux 300 Watt UVB - Lightbulb after harvest which makes them a very rich source for vitamin D2.  Now here comes the interesting part. My previously utter deficient 25(OH)D below detection level, measured at the end of summer -I'm not the outside type and almost never get enough UV-exposure from sunlight- has after a year gone up to 105 nmol/L. Given that I have nowhere near enough sun exposure, and as a vegan no other dietary source of vitamin D, it is clear to me that the vitamin D2 from my sun-dried or irridated mushrooms is responsible for my recovery from hypovitaminosis D.

Now I don't know if there's a difference of vitamin D2 in mushrooms or the pharmacological D2 in pills, all I know is that Vitamin D2 is *my* primary source of vitamin D and it's giving me excellent levels of 25(OH)D.

What I find highly irritating is the meme like argument flying around that vitamin D3 is the one "naturally appearing in the body". Duh. Vitamin D2 is also converted into vitamin D3 so the fact that D2 is not "naturally in the human body" should be as relevant that Vitamin C is not "naturally in the human body" and has to by sourced from diet. There are many nutrients that are "not natural" in the human body and which we need to source from diet, for example the essential amino acid. Besides, since when does "natural" equate to being good? If a Uranium miner has "natural" radioactivity in his body because he is exposed to it during work, is that good? I don't think so.

The reason I'm irritated is because the information about vitamin D2 being bad (when that is, at least in my case *not* true) has real implications and discriminatory effect on vegans and other vegetarians because not everybody of us has the patience and curiousity to produce their own Vitamin D at home, and perhaps some people don't enjoy eating mushrooms.

There is one more point and then I'll end my rant. Every time us vegans were informed that a particular plant based nutrient like vitamin A (beta-carot.) or iron was inferior because it has a lower bio-availability, later research discovered that that lower bio-availability has actually real benefits. I wouldn't be surprised if the same appears to be true for vitamin D2. I have already come across research which noted one of the D2 metabolites to have anti cancer properties, although this study is based on non-human animals meaning it has little to no relevance to humans and is based on the exploitation and death of rats.

For those who (despite reading this on an electronic network of computers) lay any importance on _naturality_ regarding nutrients, you may want to consider my method of just drying mushrooms in the sun. That's certainly more natural than killing sheep, stripping the hair grease of their wool and irridating that with UV-B light, which is the standard method of how vitamin D3 is produced - a byproduct of butchers waste.

Fascinating solution!

However, I stick by my claim that, for most people, vitamin D2 supplementation does not work. I have seen many people on as much as 50,000 units of D2 per day with zero or near zero levels of conversion to the active D3, all proven by blood levels.

However, for a vegan, I do not have any useful non-animal solutions beyond getting sun.

My Vitamin D levels, when first tested, were 12.  I have been using a Vitamin D lamp to try to raise the levels, which are now 32-33.  Initially, I took Puritan's Pride Vitamin D, which made me feel like a new person, but I quickly learned that it interfered with the efficacy of Cytomel, which I take because Synthroid interferes with yet a different medication.  Do you know of any form of Vitamin D that might not interfere with Cytomel?  

Thank you.

I just found out my vitamin D level is abysmally low from a blood test. My endocrinologist gave me a prescription for 50,000 units of vitamin D.  After reading about the subject here, I don't know whether to fill the prescription or go the the health food store and get a bottle of vitamin D3 capsules and disobey doctor's orders. We are investigating whether I have disturbances in my cortisol levels.  So far, testing has shown very low morning cortisol levels.

I went from sickly to healthy from taking 50,000IU (once a week) of Calciferol, proven by my recent bloodwork.  My D level was 18 in November,  and 4 months later it was 38!!!  Taking D2 has changed my life and I continue to take it without hesitation or reservation.

I have read that I should be taking a cal/mag supplement to increase absorbtion but I have not done so . . . your thoughts please.

Maybe the lab you use for blood tests isn't DEQAS certified, and isn't accurate.  I don't know how else to explain why a recent study contradicts what you're saying about D2:

http://jcem.endojournals.org/cgi/rapidpdf/jc.2007-2308v1.pdf

Hello, can you tell me what form of D3 is best and why.

Ergocalciferol (D2) has a kenetic half life of 10 days.  Calcitriol (D3) has a half life of 3 days. I am surgically hypoparathyroid and replaced 100% of that function with calcitriol or ergocalciferol for 30+ years. I find the D3 form is smoother on my body, until I forget to take my dose on any particular day. Then my mood, energy, stamina, sense of well being etc noticably deteriorate. I lived quite easily on D2 for nearly 28 years until medicare decided this life essential medication was a non life essential vitamin and forced a change to the more expensive calcitriol they would pay for. So now I painfully die in 10 days without D3 instead of 30 days if taking D2. This is germane when the price of ergocalciferol in 1991 was $1.99/100 50000IUs dose. After several years of repeated "offshore supply problems" the price is now $125/100 forn teh identical medication. Sometimes I'd drive 75 miles to another pharmacy (dealer - lol) to refill the D2 when the supply dried up. On correct fo the supply problem the price would double or triple (WTF???). Oh well - rather that a "DNR" I insist on a "JSM" (just shoot me).

Hi everyone,

Firstly, I must say I agree with ava reactions being irritated above, even if not being vegan myself, but vegetarian.

I would like also to point out that health is definitly not numbers on a paper coming from tests but is how we can feel and act.

Good health is about feeling balanced and in a state that allows personal accomplishment. It is not, not at all, about obtaining or aiming a level of that molecule or this other one in a blood test.
You can take two people with same amount of that molecule, or with similar tests results and having one feeling very healthy and being really so and the other one being and feeling desperetly ill. Blood tests reflect only very poorly what is really happening in the vast universe of our cells and tissues. It does not indicate at all how plenty of important biological reactions are going in us.

It makes me smile when I read 50,000 IU of D2 did not increase D3 levels. When you place carrots in your dish, you do not have sprouts !! The purpose of taking D2 is not about raising D3 and D3 metabolites levels but D2 and D2 metabolites ones. D2 and D3 molecules react in same biological fields, and D2 is beeing used with success for decades. It is not honnest to omit that and to pretend D2 is worthless because D3 levels do not raise : it is a false demonstration.

In my view solar exposition is the most important factor for everyone, but when not getting enough D from sun, the plant-form D (D2) is perfectly suiting. I have never read any animal study that tends to show D3 supplementation is preferable to D2; on the contrary toxicity is shown to be a lot greater with D3 hypervitaminosis than with D2 hypervitaminosis (a lot more calcifications with D3 than with D2). Plants represent the reference in food because everything we need, even B12 for example, can be found in the plant kingdom; that is not the case if the animal kingdom is taken as food. Then ask your intuition about D2 and D3 being the most desirable form of Vit. D when not receiving enough sun...

Readers should remind that there is two different 25(OH)D : the one with D2 and the one with D3, and also two 1,25(OH)2D. Measuring the D3 forms (most commonly measured in blood tests) is meaningless if you take D2 supplements. It is NATURAL having in the blood less 25(OH)D in its D3 form during winter than during summer because at that time there is less sun activity. Correcting lowering Vitamine D activity during winter with D3 supplementation rather than with D2 is illogical and unatural.

R. Jehl
Naturotherapist in France

Individualized Vit D supplementation is necessary. The arguments regardind D2, D3, single Hydroxy and double hydroxy depend on your body and its current disease status. For example, giving a D2 or D3 to a patient without kidney function is useless because they cannot convert it to the ACTIVE form of 1,25(0H)2D3. Kidney patients must take activated or the final form of vitamin D 1,25(0H)2D3. Liver dysfunction patients cannot convert the D3 to the single hydroxylated form, which the kidney needs in order for its metabolism. So, really, blank statements as given by the French provider indicating D2 for all is FALSE. Look up the metabolic pathway. If you are stone cold normal and only have low Vit D, then you can take either form of regular D2 or D3. If you have a disease, GI malabsorption, liver or kidney disease, granulomatous disease etc you should consult a professional to guide your dosage for proper results. I do like combining some fast acting forms with some slower acting forms to help folks feel better faster and then long term treating with slower forms if they can metabolize them. Everyone is unique and sometimes trial and error are required.

I have read through these posts with interest. I am new to this site, looking for a solution to my 'no beef' diet and insufficiencies in Vitamin D (3 mostly). I am on synthroid, but never knew of the Vitamin D correlation.

I find that in the US there appears to be NO 50,000 Vitamin D without bovine capsules. I cannot find a veggie tab surrounding even the D2.

Can anyone advise where I might 50,000 units of Vitamin D3 with no 'cow' gelatin coating?

Do you have any recommendations for those who are vitamin D deficient but cannot tolerate oil based capsules but have no problem with fortified foods?  Is the UV lamp a safe alternative?  Is there a powder form of D that is effective?

I've read this discussion with a great deal of interest.  I've been supplementing with Vital Nutrients capsules which are vegetarian.  They make 2000iu capsules and 5000iu capsules. http://www.vitalnutrients.net/vnestore/detail.asp?product_id=VNVD2

Hello this is Ava again from Germany, I posted a long rant into this thread some while ago.

I'd just like update that I've switched from irradiated mushrooms to a vitamin D2 supplement as drops ( Sterogyl 2,000,000 ergocalciferol ) and my 25(OH)D levels are really nice in winter at 156 nmol/L or 62 ng/ml! In France it's availalbe without perscription and we've been able to get it Germany too. It's very cheap around 2 Euro for 400,000 IUs despite the name. I started out with 13 drops / 5200 IU for 14 days, then I took a single mega dose of 300,000 IUs. Since that I've been taking 70.000 IUs once a week. I'm very tall at 6' flat and this is the dose my body needs to achieve good levels.

It's also possible to just keep on taking 3500 to 5000 every day, however it then takes much longer to reach desired serum levels.

If you have access to this cheap product and take 5200 every day, the 2.50 Euro or so will still last you almost 3 months.

Vitamin D3 Iu:

NOW Vitamin D softgels supply this key vitamin in a highly-absorbable liquid softgel form. Vitamin D is normally obtained from the diet or produced by the skin from the ultraviolet energy of the sun. However, it is not abundant in food. As more people avoid sun exposure, Vitamin D supplementation becomes even more necessary to ensure that your body receives an adequate supply. Vitamin D3 Iu on discount at NutroVita.com.

For more details please visit:
http://www.nutrovita.com/32760/now-foods/vitamin-d-3-2-000-iu.htm

When you're exposed to sun, what form of vitamin D is activated in the skin? It's all vitamin D3, no vitamin D2 whatsoever. Vitamin D3 is also far more effective than D2. People taking D3 (as long as it's oil-based) easily obtain healthy levels of vitamin D in the blood. People taking 50,000 units per day of D2 (the recommended quantity) remain miserably deficient, with minor increases in vitamin D blood levels. In short, D2 barely works at all. D3 works easily and effectively