Did the monkeys get to vote? ;)

I would LOVE to read a response from the AHA!

Come on Doc, these statistics are obviously bias. That's like asking the readers of an vegan/animal-rights blog, "Do you think meat is murder?" and trying to transpose the results as being all encompassing.

I have to agree with Anonymous here. Nothing surprising in the fact that the majority of readers of a blog that regularly criticizes the AHA have a critical stance towards the AHA.

Move along, these are not the droids you're looking for.

I think you are being a bit generous to them. I certainly agree about the ADA. They seem to be in it for the money and they are getting plenty of it from drug companies. I am a physician and a diabetic and if I followed their advice my blood sugars would be out of control. As it is I am on a very low carb life style and in excellent control!
Thanks for your posts.

certainly it's not a random sample, but nonetheless, I would have to agree that all of these organizations and government agencies are losing credibility with the public and fast.  As a health professional myself, I can only hope my colleagues may begin to soften their stance before our credibility is completely shot with the public.

Tuck, the monkeys must make up the extra 18%.

Doctor, I truly appreciate your blog, read it religiously and follow much of your advice, but before forwarding to the AHA, you might want to check the numbers.

I think the AHA has done a lot of good in the treatment of heart attacks and keeping people alive.  However, I was thinking mainly of the "prevention" side when I voted "Tries to maintain the procedural and medication..."

Likewise, the ADA and other diabetes orgs are no doubt doing some good research into causes and prevention of type 1 diabetes, but their nutritional approach is a disaster.  Again, just maintaining the status quo for so long that they would be afraid to admit they were wrong if they finally did see the light.

Their heart is in the right place. In another 40 years scientists will be deriding the intriguing bloggosphere theories.

I just dislike these organizations jumping on a bandwagon d'jour, and trying to apply it to everyone blanketly.

People are not a " one size fits all " species!  When will the AHA, ADA, etc, stop aligning with big agriculture and pharma and think of individual people and their specific needs?  Is that just a pipe dream?

Real Food RD, I'm with you!

I was going to throw the other ADA in that stack too.  I've let them know several times how I feel about their corporate sponsors and partners.  Disgusted.

To be honest... after promoting such a lifestyle for so many years... wouldn't a sudden change in opinion open them to law suits?

How can they respond to that?

Great point Brian. I hadn't even thought of it.

Wouldn't it be the same with any condition that current medical research might up- end the treatment protocols?
ie..remember when patients with gastric ulcers were advised to drink milk and cream and avoid spicy foods etc?  
Then enter H. Pylori...albeit some 10 years after published studies and much derision from U.S. gastros. Treatment standards changed dramatically. Never heard of lawsuits over that.

Could people leave more than one response?  The percentages add up to more than a hundred.
Bob

OK, I did the math.  Apparently about 375 unique respondents, with 70 or so choosing more than one answer.

My impression is that 'disease associations' exist primarily to ensure their continued existance.

I have heard good reports on the Muscular Distrophy Assoc.

Dr D, I don't think the AHA is sending you a Christmas card this year

I was wondering if you could breifly but exactly tell me what vitamin D does for your heart as far as reducing plague. I just always hear "its good to reduce plague" but how or what does it do?

There is a full special report posted on the www.trackyourplaque.com website.

Also, see my article in Life Extension Magazine on vitamin D; it should be posted online within the next couple of months if you don't have a hard copy.

Are all brands of cholecalciferol interchangeable?  How do you know how much D to take?

I am female, age 52.  I started on 2,400 IU of cholecalciferol last March because my Vitamin D levels tested at 19.  Last time I tested in August, my D levels were up to 42 (presumably because of the supplementation since I don't spend much time in the sun).  I'm also taking fish oil.

However, I wish I could tell you that I felt more sprightly like your patients.  However, I really don't feel any better on Vitamin D than off of it.  I'm either (1) a non-responder; (2) not taking the right brand of Vitamin D; or (3) not taking a high enough dose (although 2,400 seems like a lot).

We aim for a blood level of 50-60 ng/ml.

However, though I've been impressed with the energy-enhancing effects, it does not develop in everybody. Why? That's another lesson to learn. But restoring vitamin D still provides all its imperceptible benefits.

Dr Davis, 10 days ago I told you of my Diabetic wifes wonderful response to an experimental dose of 1000IU oil base gel cap D's. Her #'s dropped 20-30 points. She called her Endo requesting a prescription for a blood draw to check D level. He was unresponsive and today his nurse called and said not to take anymore, he had never read anything about D affecting Glucose levels, and He would talk to her at the next appointment. Undeterred we called our GP and he said sure,just stop in. We did and now await the #'s hoping we understand them. I am considering Faxing the Pub Med study "The roll of Vitamin D and Calcium in type 2 Diabetics" to my wifes Endo. Do you think he would be offended? .....Thanks

Dr Davis, 10 days ago I told you of my Diabetic wifes wonderful response to an experimental dose of 1000IU oil base gel cap D's. Her #'s dropped 20-30 points. She called her Endo requesting a prescription for a blood draw to check D level. He was unresponsive and today his nurse called and said not to take anymore, he had never read anything about D affecting Glucose levels, and He would talk to her at the next appointment. Undeterred we called our GP and he said sure,just stop in. We did and now await the #'s hoping we understand them. I am considering Faxing the Pub Med study "The roll of Vitamin D and Calcium in type 2 Diabetics" to my wifes Endo. Do you think he would be offended? .....Thanks

Yes, by all means.

If he is offended, it's time for a new endocrinologist. Part of being a responsible professional is a willingness to learn.

Sorry to be a pest...My wife's D checked at 42 pg/ml...what ever pg stands for? She want to take another 1000IU gel cap for a couple weeks (total of 2000IU) to see if glucose goes down more. If it does then she will retest to see if that is a safe maintenance dose. Sound like a reasonable plan?
From 180's down to 150's has been  encouraging. Many Thanks.

Sorry to be a pest...My wife's D checked at 42 pg/ml...what ever pg stands for? She want to take another 1000IU gel cap for a couple weeks (total of 2000IU) to see if glucose goes down more. If it does then she will retest to see if that is a safe maintenance dose. Sound like a reasonable plan?
From 180's down to 150's has been  encouraging. Many Thanks.

I'm puzzled.

I've never seen vitamin D expressed in those units. It also doesn't make sense. There are 1000 pg in one ng; thus, a value of 42 pg/ml would equal .042 ng/ml, a value less than 1 ng/ml, meaning virtually zero vitamin D in the blood.

Something is wrong. You might go back and verify the value.

Oct. 12, 2007

Dr. Davis:
Re: Over & out:

There are two Vitamin D test.
One is Vitamin D,1, 25-Hydroxy (Calcitriol). This test is reported in pg/ml.
The other Vitamin, D test is Vitamin D, 2-Hydroxy (Calcidiol).
This reported as ng/ml.
I think this should be the Vitamin D test to be ordered.
I made the same mistake, before.

So, I think Over & Out should have her test redone, on Vitamin D2-Hydroxy (Calcidiol).
I have mine done thru, Directlabs.com., blood drawn at Labcorp.

Thanks,

Your a genius! We attached your text (minus your name so they wouldn't T.P. your house)and went to Paul Oliver Hosp. In Traverse City, MI. "Whats up with this" we asked. "Oh, we ran the wrong test" this is for a 1,25 OH Vitamin D test.
So now its the weekend and we will have to wait till Mon-Tues for the real results. What a miatake we could have made without your generous help. Many Thanks ...big time.

Your a genius! We attached your text (minus your name so they wouldn't T.P. your house)and went to Paul Oliver Hosp. In Traverse City, MI. "Whats up with this" we asked. "Oh, we ran the wrong test" this is for a 1,25 OH Vitamin D test.
So now its the weekend and we will have to wait till Mon-Tues for the real results. What a miatake we could have made without your generous help. Many Thanks ...big time.

Ah, that makes sense. Thanks.  

However, it's the 25-OH-vitamin D3 that we measure, the effective form, not D2.

You are actually shooting for 60-60-60-60 (LDL TG HDL, vit D-25-OH)! I can't wait to see an RCT on the results of your interventions. do you think your results will beat Vit B3 (ie niacin) + zocor 40mg/d from the HATS trial with a better than 90% reduction in secondary CAD?  I would wager the results will trump. i hope the doubts are put to rest.
I've recently test my own vit d and am so confounded they are so low (21 ng/ml) for living in sunny Cali, taking my kids to swimming for hours in the summer 2-4 days/wk, running 3-4 half-marathons and a mini-triathlon every year...  is it really all the sunscreen causing this silent pandemic of deficiency?  is there a point in screening. it seems everyone is deficient, even if the dark toned individuals who spend hours in the sun daily. i'm only 30-something, not obese (bmi 18.5). i've even checked my glucose (i'm an educator) and surprised to find it > 160 after a rare sugary drink. also i never use my asthma inhaler in the summer but found i needed it without being sick... i may need to go sun myself and get D3 3000-4000 IU/d to get the level up to 60. i'm so bummed. but glad to not be in the dark (pun intended)  thank you again for your excellent insights.

Lipitor is 'doing the D'!
you've probably seen this (the post-1yr leves are still very low << 80 nmol/L)...  


Effects of Atorvastatin on vitamin D levels in patients with acute ischemic heart disease.

Am J Cardiol. 2007 Apr 1;99(7):903-5

Authors: Pérez-Castrillón JL, Vega G, Abad L, Sanz A, Chaves J, Hernandez G, Dueñas A

Vitamin D deficiency is a risk factor for osteoporosis and other chronic diseases, including type 1 diabetes, hypertension, metabolic syndrome, and ischemic heart disease. Cholesterol and vitamin D share the 7-dehydrocholesterol metabolic pathway. This study evaluated the possible effect of atorvastatin on vitamin D levels in patients with acute ischemic heart disease. Eighty-three patients (52 men and 31 women) with an acute coronary syndrome (75 with acute myocardial infarction and 8 with unstable angina) were included. After diagnosis, patients received atorvastatin as secondary prevention. Serum vitamin D was measured by high-performance liquid chromatography at baseline and at 12 months. Atorvastatin treatment produced a statistically significant decrease in cholesterol and triglyceride levels and an increase in vitamin D levels (41+/-19 vs 47+/-19 nmol/L, p=0.003). Vitamin D deficiency was decreased by 75% to 57% at 12 months. In conclusion, atorvastatin increases vitamin D levels. This increase could explain some of the beneficial effects of atorvastatin at the cardiovascular level that are unrelated to cholesterol levels.

PMID: 17398180 [PubMed - indexed for MEDLINE]

Isn't that interesting? I saw that, too, but was impressed with how little discussion it seemed to generate. Perhaps we're all becoming oversaturated with the statins do this, statins do that reports. But  I thought this one also merited special attention.

That is impressive. Factors that contribute to vitamin D deficiency would include:

1) season--even in LA, the sun is increasingly indirect.

2)Lifestyles--with more time spent indoors and in cars; you probably wear clothes most of the time!

3) Sunscreen, as you point out, is very effective to block vit D conversion.

4) Genetic factors

5) Skin color--The darker you are, the longer it takes to obtain D.

I believe that our results will like be superior to a HATS-like experience, though they are two different populations, ours being lower risk. Event data will come eventually. We are currently focusing on surrogate measures of atherosclerosis first.

You are awesome -- thank you for  your thoughts!!  yes, usually i'm clothed!  but wore the requisite suit at the poolside and perhaps increased the natural SPF in the skin as a consequence?  The more tan, perhaps the less skin activation of D3?  I'm a tan asian american (I was 'black' as a kid playing in the 'hood, but, now no longer to avoid you know wrinkles)

As a rph, I read the life extension article and really appreciated the list of potential adverse effects with Vitamin D.  Do you routinely ck urine for calciuria?  When do you see this happen?  Do recommend checking annually?

somehow you remind me of Tony Soprano but instead of knocking people off, you're HELPING PEOPLE STAY ALIVE...  Keep up your strong work.

Thanks, much, G.

No, I don't routinely check calcium in the urine nor in the blood. It is rare in an otherwise healthy person to see any adverse disruptions of calcium. In fact, most people who are deficient in vit D (nearly everybody!) show a modest drop in serum calcium, reflecting less mobilization of bone stores, a healthy effect.

I would just like to say that your blog has really helped me.  My father just turned eighty and neither his primary doctor (who handles his heart disease) nor his Alzheimer's doctor has ever tested his vit.D levels.  When I inquired about him possibly adding fish oil and vit.D a year ago, both doctors looked at me like I was an an insane person. They dismissed me and I thought, hey, they are the ones with M.D.'s after their names.  Well, after recently educating myself with your blog, I insisted on a vit.D test and sure enough, the nurse said it was very low although she declined to tell me the actual level.  She said my father's primary doctor would follow up with us.  With the fish oil, the doctor said it is much better to get it from food and I said we don't eat an Eskimo diet!!  She said taking the fish oil wouldn't hurt.  But again, no guidance as to amounts.  Could you recommend amounts of both the vit.D gelcaps and fish oil for my 80 year old dad and myself (37 year old female)?

Thanks for your kind comments. Unfortunately, I cannot dispense individual advice.

However, an average dose in my patient 80 years and over is 6000 units for a male; 35-40 year old females usually require 2000-4000 units per day. Of course, needs vary depending on body size, region of the country, sun exposure, race, etc. These are ballpark figures.

Always keep in mind that Vit D works far better when in gelcap form.

I take it back!  you're not that Tony-esque... you're more akin to Emeril Largesse... spreading the LOVE (heart)!! and keeping the ticker ticking!  continue the strong work!  

How detrimental is caffeine (ie, 2-3 shots espresso or green tea daily)?   1 glass red wine daily?  UV B tanning booth? (I'm considering the last vice since I'm tiring of taking pills)
In Wisconsin, do you ever lay out or hit the tanning salon?

BTW, I have lived your low carb, moderate fat diet -- totally works! lost 45 lbs over 4 yrs after my children were born (coupled with strength training and yoga).
I've convinced some of my diabetes pts -- but it's very hard for people to give up the pasta and rice.
What are your thoughts on Fibrates (very good data from the DAIS and VA-HIT)?
How about Plant Sterols (which is sold at Trader Joes -- LOVE THAT PLACE  -- they carry the oat bran, raw nuts and flaxseed you endorse -- I love their LOW GLYCEMIC FLOURLESS Ezekiel bread!)? it apparently is being added to EVERYTHING including milk and OJ soon... it's already mixed with margarine (yeck)

Those are all great ideas. Tanning beds can indeed activate vitamin D, similar to sun exposure.

I love Trader Joe's, too. We just got our first in Wisconsin about one year ago. It saves me a lot of driving back and forth to Chicago.

Fibrates--I use them only occasionally, as a second choice to niacin, since niacin is much more powerful in effect.

Please see our newsletter archive at www.trackyourplaque.com for a full discussion of the potential DANGERS of sterol esters. Stanol esters like those in Benecol are safe. But sterol esters can potentially be absorbed into the blood.

Thanks for the plant sterol FYI!

Should D3 be renamed...  it seems to be implicated in so many other functions (cardiac, CKD/PTH, reproductive, autoimmune, TSH, dyslipidemia, Type 1 and Type 2 DM, hypertension, cancers, osteoporosis, the list goes on)... something like DVH which would stand for 'D3 VITAL hormone'

What are your thoughts on DHEA (and Testost replacement)? Do you titrate the dose to patient's tolerance, to symptom resolution or a physiologic levels?  For testost our lab normals are female T > 20 ng/dL; male  T > 260 pg/mL)...  Thank you for any input!

I'm so grateful for you sharing your compelling observations on the effects on HDL and CAD reversal!  here's another interesting article... D3 (and calcium -- i think it's D3 dependent effect) on HDLs!

Am J Clin Nutr. 2007 Jan;85(1):54-9.
Supplementation with calcium + vitamin D enhances the beneficial effect of weight loss on plasma lipid and lipoprotein concentrations.Major GC, Alarie F, Doré J, Phouttama S, Tremblay A.
Division of Kinesiology, Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Ste-Foy, Canada.

BACKGROUND: Adequate calcium intake can have a favorable effect on some metabolic variables. OBJECTIVE: The objective of the study was to determine the effects of daily calcium intake and of supplementation with calcium and vitamin D (calcium+D) during a weight-loss intervention on blood pressures, plasma lipid and lipoprotein concentrations, and glucose and insulin concentrations in low calcium consumers. DESIGN: Healthy, overweight or obese women (n = 63) with a daily calcium intake of < 800 mg/d were randomly assigned in a double-blind manner to 1 of 2 groups: the group consuming 2 tablets/d of a calcium + vitamin D supplement (600 mg elemental calcium and 200 IU vitamin D/tablet) or the group consuming placebo; both groups observed a 700 kcal/d energy restriction. These 63 women then completed a 15-wk weight-loss intervention. RESULTS: Initial daily calcium intake was significantly correlated with plasma HDL cholesterol (r = 0.41, P < 0.001) and with 2-h postload glycemia (r = -0.29, P < 0.05) during an oral-glucose-tolerance test, independent of fat mass and waist circumference. After the 15-wk intervention, significantly greater decreases in total:LDL and LDL:HDL (P < 0.01 for both) and of LDL cholesterol (P < 0.05) were observed in the calcium+D group than in the placebo group. The differences in total:HDL and LDL:HDL were independent of changes in fat mass and in waist circumference. A tendency for more beneficial changes in HDL cholesterol, triacylglycerol, and total cholesterol was also observed in the calcium+D group (P = 0.08). CONCLUSION: Consumption of calcium+D during a weight-loss intervention enhanced the beneficial effect of body weight loss on the lipid and lipoprotein profile in overweight or obese women with usual low daily calcium intake.

PMID: 17209177 [PubMed - indexed for MEDLINE]

Hi, G--

I use both DHEA and testosterone for specific lipid/lipoprotein treatment, e.g., DHEA in men and women to (modestly) reduce Lp(a), testosterone to reduce Lp(a) in men.

Both can also be used to increase physical stamina, erectile capacity, and mood. I'd invite you to read our full length Special Reports on each of these topics on the www.trackyourplaque.com website.