Celiac disease is often noticed by people who go off wheat for health reasons, then when they try to eat it again, it makes them sick.  

For the record, Corn Flakes contain barley malt which has the same protein, gliadin, as wheat.  I have celiac and the "formula" is no wheat, barley or rye because they are so closely related and have the same "gluten" protein.

Isn't it interesting. They treat obesity by fixing the "mesolimbic reward system" because they believe eating too much "food" makes us fat. But then you say wheat isn't food, it's a drug.

Are we really eating too much "food"?

A heroine is a very different concept than "heroin."  And withdrawal from oxycontin or heroin is unlikely to cause hallucinations or seizures (Trainspotting babies on the ceiling notwithstanding) - though it is exceedingly unpleasant, it is not typically medically dangerous.  Perhaps you are thinking withdrawal from alcohol, barbituates, or benzodiazepines, all of which can cause hallucination, seizures, or death if done without medical supervision.

I have celiac and had similar problems when I first went off gluten.  It took me about a month to stop reacting.  I get quite ill whenever I accidentally am exposed to gluten, say at a restaurant.  My symptoms are migraine and flue like aching in my joints, plus severe fatigue.  None of my doctors thought I might have celiac by the way, because I am slightly overweight (BMI 25) and didn't have severe digestive symptoms, but there is recent research showing that many patients present with migraine as their only celiac symptom.

Oohh. Thanks for catching the typo, Dr. Deans. Fixed.

By the way, I've seen plenty of hallucinations and seizures with opiate withdrawal, as well as benzodiazepine withdrawal. Or, perhaps it was combination addictions that were at fault.

That, however, was not the point.

I think the point was well-made - just didn't want anyone to fear that wheat withdrawal was medically dangerous (quite the opposite).  I've had a few cases where I was able to stop night (carb - typically bread) binging with (off-label) use of naltrexone - pretty telling, I would say.

Dr. Deans--

I am VERY impressed you knew of this effect.

I have tried this, too, in people who are, despite their best effort, unable to resist temptation to consume this drug-disguised-as-food called wheat.

My health improved dramatically after I stopped eating wheat, grains, and other carbs, I even had a cataract disappear.  But it required nine months before I could adjust to the low carb way of eating. It's worth all the trouble, no more high blood pressure or diabetes medicine.  Most of my arthritic pain is gone, I am able think more clearly. Lost 30 pounds. No more allergies or indigestion.
Thank you for writing this blog!

I was able to stop night (carb - typically bread) binging with (off-label) use of naltrexone - pretty telling, I would say.

Nothing at all particularly telling I would say. Other than telling that opioid receptors are part of the reward circuit. Which is obvious and not disputed by anyone. Naltrexone main use is in treatment of alcohol dependence. Using your logic ethanol is an agonist of opioid receptors. Which is self-evidently not true. The effects are indirect.

Question here:

Is the "craving" for wheat due to psychoactive tri-peptides derived from wheat protein ?  If that is the molecule that "dopes" our opiod receptors then decreasing levels of tri-peptides as the day progresses will make some look for their wheat "fix".

Naltrexone @50mg was FDA approved (1984) in 1984 opiod addition; to block receptors. I think the doctors here are referring to single evening doses of 3 to 4.5 mg.
for screened patients.

Here's what I don't understand: Why is it that entire countries of people who eat bread by the basket, like Spain, have exceptionally low levels of heart disease? This is a sincere question. I want to do what's right for my heart, but it seems to me that a naturally occurring sample size of several million people is pretty compelling. What am I missing?

Jack LaLane on sugar:

http://www.youtube.com/watch?v=LJVEPB_l8FU

Milk and dairy products are also a source of endorphin-like chemicals. Would it make sense to try to kick a wheat habit by temporarily drinking more milk?

BWR

It is possible that Spanish bread is made from a much healthier wheat variety.

The devil is on the details.
From a HSB comment May 24, 2010
Here in France, Einhorn( Triticum monococcum) has been cultivated since the 9 th millennium BC in a small area of Haute Provence. It is called petit epeautre and it is truly delicious! It has very little gluten.
There is much regulation in the cultivation in order to protect the genetic purity of this ancient grain. Like wines it has a AOC (appelation d'origine controlee

Please note: Higher Mg and Lysine in einkorn

Modern wheat has had much of the Mg bred out
http://petitepeautre.com/nutritiona.html

Scandinavian Journal of Gastroenterology
http://www.einkorn.com/toxicity-of-einkorn-gluten/

Same for casein in milk where A1 milk can be a serious problem and the casein is similar to gluten
http://www.guernsey.net/~wgcf/PageMill_Resources/Acres_Woodford.pdf

Hi, BWR--

There are some unanswered questions with this thing called wheat. As the anonymous commenter pointed out, there may be differences in strains grown worldwide. While 99% of all wheat grown today are dwarf variants of Triticum aestivum, there are pockets of agricultural adherence to older cultivars.

I am perfectly willing to believe than many people cannot tolerate wheat. But this obsession with villifying wheat discredits Dr Davis's very valuable promotion of regular heart scans and other diagnostics, as well as D3, Iodine and other supplements.

It isn't just the Spaniards. My own ancestors are a mix of French, German and English, and I don't seem to have any problems with wheat, rye, barley, to speak nothing of oats. Furthermore, I believe a heavy grain diet is precisely why I am able to keep my weight down and my test results good. I experimented with going to a somewhat more paleo diet recently and the result was to DECREASE my insulin sensitivity when I went back to eating oats. Now that I'm back to eating mostly oats, my insulin sensitivity has returned to normal. Worse, the paleo diet caused a surge in uncontrollable hunger. One particularly bad day, I ran through a dozen eggs, a pound of meat, another pound of nuts and all sorts of other food before my appetite finally settled down. I never had these uncontrollable appetite problems with my usual mostly oats diet, nor did I have problems when I used to eat mostly pasta (though I was younger then and had higher metabolism than now).

Appetite is the key. If a food sends appetite soaring, then it doesn't matter how healthy that food is by itself--it will make you fat and thereby reduce insulin sensitivity and thus destroy you in the end. Conversely, if a food depresses appetite, then assuming it isn't absolute poison (like arsenic), eating that food will allow you stay lean, and by staying lean you stay insulin-sensitive (assuming you also do some daily exercise), and that is the ultimate key to avoiding most health problems, from what I understand. For some people, wheat and oats may very well be the keys to appetite suppression, and it is thus a disservice to condemn these foods for everyone.

what do you make of this new study citing adverse effects of a high fat diet?

http://www.ajcn.org/content/early/2011/01/26/ajcn.110.002758.abstract

@revelo,

In his practice of Cardiology, Dr. Davis has apparently observed great results with a good number of his patients that choose to avoid wheat. Apparently, an impressive enough effect, in his opinion, to make the statements that he does. These observations, and the recommendations he makes based upon them, hardly "discredit" his professional advice.

It may be true, as you suggest, that not every single person will have a problem eating wheat, but a person's weight (or appetite) is not the only indicator of potential heart-health related issues. While wheat might not make everyone fat, it may still provoke immune response, inflammation, surge in blood glucose and triglycerides, etc.

Anecdotally, thanks to Dr. Davis' advice regarding wheat, my 68 year-old mother lost 15% of her bodyweight in four months, without exercise, and without any other change in her diet except to replace the pastas and breads with eggs, vegetables, and meats. She had always taken great pride in the "healthy" foods she ate, but over the past twenty years had very slowly gained weight and a bloated appearance. She started crying during our last visit because she is so happy to "recognize" herself again in the mirror, and is wearing clothes that haven't fit in over a decade. I stopped eating wheat one year ago. Since then, I've dropped from size 34 to 28 pants and get compliments weekly concerning how young I look; I feel great and lab results (blood tests, radiology) are unbelievably improved.

Wheat avoidance may not indeed be necessary for everyone; but, it's done wonders for *all* of those around me that have given it a good chance.

Jonathan,
Subbing milk for the wheat wold NOT work as milk produces a morphine- like substance called caseomorph and wheat produces gliadimorphs. Two different types of exogenous morphines.

This is one of the rationales for the gluten free- casein free diet that seems to greatly help some children on the autistic spectrum.  Sorry to be a spoilsport!

oops!  typo alert ...sorry
Subbing milk for the wheat would NOT work as milk...

reikime,
thanks for the answer.

You're welcome Might-.

Check out www.theglutensyndrome.net

I get folks who contact me from my site who have strange neurological symptoms when they either withdraw from gluten/wheat the first time or  flip flop on and off too much. I have a page on temporary adverse effects from going gluten free.

Our 23 year old nursing student daughter experienced a very strange neurological effect from a 6 week gluten challenge after being strictly gluten free for 6 months.  Ischemia/reperfusion injury is a possibility, and gluteomorphin withdrawal also.  Her story is on the site.  For sure she is very strictly gluten free now, and doing fine 6 years after the experience. http://glutensensitivity.net/cases.htm#ztop

In the book, "Mendel in the Kitchen, Nina Federoff, a strong proponent of GMO technology, relates how wheat was genetically altered by the 1950's by both x ray irradiation and chemical mutation, and the gluten levels were raised far above older varieties. The wheat today is not the same as our ancestors, at least not here in the States.

FYI, a new lab (www.Cyrexlabs.com)  has just opened 2 weeks ago with much more complete gluten syndrome testing.  They are testing many more antibodies than previous standard panels, and expected to turn up many more folks with gluten syndrome.  They also teach that gluten can damage multitudes of tissues by molecular mimicry between gluten related antibodies and look alike innocent tissues all over the body.  The villi, which have been the gold standard target tissue in the celiac community, are turning out to be just one of many possible sites of damage.  

Many folks have gluten/wheat related antibodies, but their main target of autoimmune tissue damage is in places other than the villi, such as the heart, nerves, organs, joint lining, etc.  Villi as the target tissue is found in relatively a few folks, and that is the tissue damage that has gotten most of the attention.

Dr. Aristo Vojdani, PhD, Immunology, and others have accumulated a lot of research to support these theories, and they fit the gluten syndrome community like a glove.

>> "Subbing milk for the wheat wold NOT work as milk produces a morphine- like substance called caseomorph and wheat produces gliadimorphs. Two different types of exogenous morphines."

Right, but is the fundamental problem generally the morphine-like effect, or is it some other antigen specific to gliadins? My wife has hashimoto's thyroiditis, and the smallest trace of wheat, barley, or other gliadin grains quickly makes her miserable... she can feel her thyroid swell, she gets cold, she has other problems. Dairy does not have this effect. Since cutting out gluten from grains, her T3, T4, and TSH levels have returned to normal, while her anti-thyroid antibody level has dropped to very near normal.

I am willing to consider that with some conditions (like autism), both gluten and milk can be a problem. It is not clear to me that if gluten is a problem then milk must also always be a problem. If the casomorph proteins allows some people to quit wheat with fewer withdraw symptoms due to the substitution of endorphin-like molecules, that could be a good thing.

Jonathan,

The issues your wife has with gliadin really dont seem related to the morphine like responses some people have with gluten and /or dairy.

Sure some people that have a wheat/gluten intolerance can ingest dairy just fine...that said, if the microvilli are damaged from wheat and not healed yet, you are much more likely to have a problem with dairy.
The tips of the villi are where lactase is produced.
Also, if one is subject to the effects of gliadiamorphins, IMHO one would likely be sensitive to caseomorphins, because the unhealed intesine is permeable.. ie leaky gut syndrome. This allows proteins into the bloodstream that would normally not be there. (and to wreak havoc)

Willing to say I may be wrong, though. Anyone?

I spend alot of time on celiac  research issues, so naturally this is where my brain goes!  lol

Great to see that others have identified gluten as a potential pathogen/allergen that can significantly contribute to both mind and body deterioration through compromised immune dysfunction. I know you, Dr Davis, often think of the heart as the canary in the coal mine, and I see the brain as a canary partner showing first signs of impending acute deterioration.

This link will take you to a series of interviews I did with Dr Peter Osborne on similar issues as discussed in this posting:

http://www.youtube.com/watch?v=dJCZmNzkRNA&playnext=1&list=PLD61FCED98A4A5C66

Hope this helps encourage more discussion and awareness, and thanks for your excellent work!
cp

[...] The first couple of weeks without grains and sugars were not pleasant.  In the beginning, I had a headache nearly every single day.  By body was detoxing and coming off the caffeine, carbs and sugars.  I was crazy tired.  For several days, I was so ravenous I wanted to gnaw my arm right off my body (would somebody please pass the sea salt…?)  If this lifestyle is sooo healthy, why have I been feeling like I’ve been run over twice by a dinosaur?  The answer is simple and thanks to in-depth research before starting my journey, it is something that I anticipated would happen – I have been experiencing the classic symptoms of Low Carb Flu. [...]

The FDA should have fully analyzed the data before granting approval to Rosiglitazone. It is my opinion that all drug test data should be public domain on all approved drugs or medical equipment (stents, pace makers, etc.). That is the only way that a patient can truly give informed consent to using them.

Yeah, probably most of the time it is self-inflicted except when you look at the nutritional recommendations and grain heavy diet being pushed by the US government, and even the ADA (!) the whole idea that grains are so darned healthy is probably responsibile for a lot of the diabetes in our society.

Rosiglitazone has also been associated with macular edema. This improves when people discontinue the drug. It is also thought to increase the risk of bone fracture.

Good timing for my father on this blog post.  It isn't heart disease but next week my father is driving to Chicago to have his head examined with an MRI to learn the potential of having an aneurysm. (I think I said that right, aneurysm)  I asked him why and he told me the exam is "free".  I don't much about how hospitals are run but from my experience every time I've been to one nothing was free.  If anything everything bought was 10 times normal price.  I've warned my father not to fall for scams - nothing is free dad.  My guess is this is a way for the hospital to drum up $100,000 business from the unsuspecting sucker.

Even more important is the danger from the high levels of radioactivity exposure caused by those scans. There was a study published that looked at the CT scan exposure of ER patients and found that the cumulative level was far over the level known to cause cancer.

Science News report.

CT scans should be used only when justified by a very real and present danger. And even then often X-rays would be a better choice.

Just when I thought the profession could not sink lower!  This seems to be another example of the current philosophy - "sick until proven healthy."  Unfortunately, this type of doctor doesn't recognize anyone as healthy. Oy....

Great analysis.

We hosted a health care forum on 14 May and during the Forum, one of the doctors said, "we're wasting money trying to prove that healthy people are healthy."

So true.

Asymptomatic and they're being entered into a study which includes invasive "bypass" as a clinical intervention?

Brain dead.

You know, that's actually terrifying.

I really can't *imagine* anyone signing up for this study.

After a week of heartburn, I spent the night screaming and vomiting before an unsuccessful emergency angio.  And after all that, while on narcotics and IV heparin, I had to be "talked into" a bypass.

I can't imagine doing it for the sake of science.

Maybe "size matters" and maybe not so much. I am only 5'3" and 117 lbs yet I require 8000 iu/day to hold steady at around 50 ng/ml.  So small body needs large dose. I have seen the opposite as well.

I totally agree that the current recommendations are absurd but appropriate dosage for Vitamin D cannot be determined by body size nor any other observable I know of except for blood testing.

Grassrootshealth have recently published new data on responses to vitamin D supplementation.
A 25(OH)D test shows how your body responds to oral supplementation / sun exposure.
Everyone responds individually, most people require more than expected.
Remember in the same way our natural production of the anti-inflammatory anti-oxidant cholecalciferol has been disrupted by current lifestyle changes so to most people fail to get sufficient sleep, so production of the other anti-inflammatory antioxidant, melatonin, is disrupted by light at night and insufficient exposure to bright light during the day.
We make a  very good job of totally wrecking our natural secretion/production of anti-inflammatory anti-oxidant protection.  It's such a shame inflammation and oxidation create dysfunctional mitochondria resulting in metabolic syndrome, diabetes, heart disease cancer and Alzheimer's etc.
Pity we haven't sufficient common sense to go to bed early and spend time outdoors in the midday sunshine.

Vitamin D supplementation does not work in linear manner.  From International Journal of Cancer Research 2011 (pdf link on request by commentators):

Starting at the following vitamin D ng/ml participant levels and adding on increments of 1,000 25(OH)D supplement daily:

10 ng/ml + 1,000 D = 11 ng/ml
30 ng/ml + 1,000 D = 38 ng/ml
50 ng/ml + 1,000 D = 55 ng/ml
90 & above each 1,000 D adds 1.6ng/ml

* and 10,000 IU D daily put no one over 200 ng/ml "toxic" threshold
* and 50,000 IU D daily would be required to surpass 200 ng/ml and be toxic

Geoffrey: I completely agree.  I take 10,000 IU/day and at that I STILL only had 41 ng/ml in February.  My GP, who is, well, of substantially lower mass than I am -- probably to the tune of 100 lbs less, at least -- is in pretty much the same boat regarding dosage and results both.

While I don't disagree... we live in a culture were I'm sure their lawyers are telling them not to change their opinion.

Can we expect these expert associations to change their opinion when they are probably faced with law suits up their ... if they do?

Loved his post.
I have added graphs to IU which should be added for age, skin color, latitude, season, etc.
http://www.vitamindwiki.com/tiki-index.php?page_id=1460

The real deal with IOM's recommendation is that it is simple minded. It's more than conservative; it was doomed from creation. An RDA is a failed way to attempt to convey helpful nutrition information to the American public. Sometimes it takes more than one number to convey something of value, and sometimes oversimplifying a concept does more harm than the good generated by its discovery.

Size in weight, of different adults, is probably less of a factor in the D levels they each get from the same IU D taken as a supplement . The measurement is of our D in fluid concentration (ng/ml), not kg. of our body.

A 13 month baby dose of 600 IU/d
is safe for their blood volume. Adults have more blood volume than infants; the weight difference is a distraction (I think).

Between "average" adults we've
similar amount of blood volume.
Two "average" height adults taking the same dose of vitamin D (like rfrancis describes) are likely starting from a different baseline on ng/ml.

Data I reported was for 5 years tracking +/- 3,400 non-hispanic white adults : age 52 +/- 13 years; weight 74 kg. +/- 17 kg.; height 1.71 mt. +/- 0.10 mt.; latitude N. +/- 40.2*; women = 2090; men = 1312.

For some people who are taking a high dose of D3 and are not getting adequate levels as indicated by 25-hydroxy vitamin D test, 1,25 dihydroxy-vitamin D must be checked as well. They might be hyperconverters.

HI, Henry--

Wow! Nice work.

Anyone wanting to see a graphic representation of some thinking about vitamin D, take a look at the graphics commenter Henry Lahore created:http://www.vitamindwiki.com/tiki-index.php?page_id=1460


Hi, Daniel--

Well said!

One thing I would like to see noted on Vit D levels is the name of the lab that does the test. I believe there are only 2 labs in the US that do the test: Lab Corp and Qwest Labs. The reference ranges are different (Lab Corp 32-100 and Qwest 18-77)

I had my D tested in July of 2008 and was found to be low (15.8 Lab Corp). My doctor gave me the standard script for 50,000 units 1x a week. I knew that D3 was suppose to be superior to the D2 that was prescribed. I decided to go with the D2 for the first 8 weeks, then switch to D3 for the next 8 weeks to compare the results and rate of rise in Vit D levels.

On the D2 my levels went DOWN to 14.9! I was shocked. The nurse pretty much called me a liar and said I hadn't taken the D2. Not only did I take it, I was fanatic about it. I enjoyed the chance to do a small interesting experiment on myself. I then switched to D3 (Carlson Labs brand) for the next 12 weeks at 50,000 units a week. That brought my level up to the low 30s. I quit following the docs advice of 50,000 units per week and increased to 100,000. That got the level up in the 50s. I then read an article by the Iowa bone center in Waterloo, IA that recommended 150,000 units per week. After 4-5 months of that my level was 77. I now take 100,000 per week and am waiting to retest.

I take 10,000 u soft gels by Carlson Labs, and they are small enough to be easy to swallow. I get them at Vita Cost online, current price is $10.93 for 120.

(I am not affiliated in any way with Carlson Labs, their products just work well for me.)

"The Institute of Medicine kept thinking about vitamin D somewhere in the Stone Age"
If they did we would all be better off. You can gauge the optimal evolutionary level of vitamin D by looking at present day hunter gatherers. I don't have time now to find the link but it is in the 40-50 ng/ml range.

"You can gauge the optimal evolutionary level of vitamin D by looking at present day hunter gatherers. I don't have time now to find the link but it is in the 40-50 ng/ml range."

Reference please !

I think you will find that the highest vitamin D levels are found in northern Europe.

Vitamin D production from UV radiation: The effects of total cholesterol and skin pigmentation

RIP Frank Garland

My 71 yo husband's recent test came out surprisingly high at 111! The doctor advised him to stop taking extra vitD. He's been taking 2000IU for at least 2 years and his number was always around 50. Nothing else has changed. He only goes out into the sun maybe once a week for an hour or less.

Are mistakes common in these test results?  

I guess he'll have to retest soon to see.

Para-thyroid hormone rises and  the kidney tubules re-absorb calcium; then inactive 25 D is converted into active 1,25 D. If someone can show me cholesterol controls our para-thyroids I'd like to hear.

Low magnesium in circulation stops para-thyroid up-regulation.
Adequate magnesium is desireable for down the line active 1,25 D production.

I'm 6'2'' and 200 and so far I haven't been able to get my level above 31. I went from 3,000 to 5,000 units and picked up maybe two points. I switched to carlson oil based capsules and bumped it up to 8,000 a day. Wondering if I should push it to 12,000 (caps are 4,000 apiece). I plan on re-testing in August.

Kenneth

"I believe there are only 2 labs in the US that do the test: Lab Corp and Qwest Labs."

Single test:
http://www.zrtlab.com/vitamindcouncil/home-mainmenu-1.html?page=shop.product_details&flypage=flypage.tpl&product_id=4&category_id=1

If you trust the accuracy of blood spot tests for Vit D (and the Vit D Council seems to!)--
4 test kit:
http://www.zrtlab.com/vitamindcouncil/home-mainmenu-1.html?page=shop.product_details&flypage=flypage.tpl&product_id=5&category_id=1

For some, when the level of (inactive) 25 D hits 30 - 40 ng/ml the para-thyroid feedback loop kicks in. The hormone secretion diminishing then causes  a 25 D production down shift.

When the (active) 1,25D is being generated in the kidney tubules it draws down on the pre-cursor 25 D. For some individuals they might see measured blood level of 25 D drop then; if liver synthesis or fat storage slow to respond.

One commentator M.D. here made the point that we want to measure 25 D and not 1,25 D. It seems what's available on demand is more significant than what got activated already.

In November 2010, my vitamin D level was tested with the 25(OH)D, twice. The first result was 12 ng/ml and the second results (a week later) was 7 ng/ml. My doctor prescribed 50,000IU/week. I took that for about 8 weeks and through some more in-depth research which led me to this blog, I discovered the difference between D2 and D3 and, of course, my prescription is Ergocalciferol. At that point, I bought the Kirkland-brand 2,000IU D3 gelcaps and have been taking them (4 per day = 8,000IU or 56,000IU/week) since early- to mid-January. My levels were re-tested again on February 18, 2011 and it is 46 ng/ml.

Is that a quicker-than-normal increase in the 25(OH)D? It seems very quick for the level to rise 34-39 ng/ml. Should I reduce the dosage at this point or maintain it at 8,000IU/day for the next 3 months to see what the level does?

Thanks in advance for any advice or guidance those in the know can provide!

Jeff

Dr Davis,
  I'm unable to get Vitamin D3 (cholecalciferol) in India. What is being sold is calcium + Vitamin D3 or Alfacalciferol or Calcitriol (http://en.wikipedia.org/wiki/Calcitriol).
While I couldn't find much about alfacalciferol, Calcitriol's composition looks very similar to what you describe.  
I wonder if they are the same.
-Neelesh

Dr. Cannell's arguments make a lot of sense, but his statement that "If he doesn't know how to measure it, weigh it, or spell it, chances are he doesn't know much about it." would carry more weight if he hadn't misspelled nanogram in the immediately preceeding sentence.

I like the Feng Shui or symmetry of 60-60-60-60....

Actually it's 60-60-60-60-60 if you include Apolipoprotein B...
(although I know you are achieveing TGs<45!)

This is great!  Thank you, g

Those readers who want to check what the research papers actually said may find the NUMBERS that I have emboldened useful. If you just cut and paste the darker number into the search-box at pubmed it should bring up the right paper.
Moan J, et al. Colon cancer: Prognosis for different latitudes, age groups and seasons in Norway. J Photochem Photobiol B. 2007 Sep 19 18029190
Lagunova Z, et al. Prostate cancer survival is dependent on season of diagnosis. Prostate. 2007 Sep 1;67(12):1362-70 17624920
Porojnicu AC, et al.  Changes in risk of death from breast cancer with season and latitude: sun exposure and breast cancer survival in Norway. Breast Cancer Res Treat. 2007 May;102(3):323-8.17028983

Porojnicu A, et al.  Season of diagnosis is a predictor of cancer survival. Sun-induced vitamin D may be involved: a possible role of sun-induced Vitamin D. J Steroid Biochem Mol Biol. 2007 Mar;103(3-5):675-8. 17229569

Porojnicu AC, et al.  Season of diagnosis is a prognostic factor in Hodgkin's lymphoma: a possible role of sun-induced vitamin D. Br J Cancer. 2005 Sep 5;93(5):571-4.17229569

Lim HS, et al.  Cancer survival is dependent on season of diagnosis and sunlight exposure. Int J Cancer. 2006 Oct 1;119(7):1530-6.16671100

Zhou W, Vitamin D is associated with improved survival in early-stage non-small cell lung cancer patients. Cancer Epidemiol Biomarkers Prev. 2005 Oct;14(10):16214909
Berwick M, et al.  Sun exposure and mortality from melanoma. J Natl Cancer Inst. 2005 Feb 2;97(3):195-9.15687362
Tangpricha V, et al.  Vitamin D deficiency enhances the growth of MC-26 colon cancer xenografts in Balb/c mice. J Nutr. 2005 Oct;135(10):2350-4.16177194

Schwartz GG, Skinner HG. Vitamin D status and cancer: new insights. Curr Opin Clin Nutr Metab Care. 2007 Jan;10(1):6-11.17143048

Woo TC, et al.  Pilot study: potential role of vitamin D (Cholecalciferol) in patients with PSA relapse after definitive therapy. Nutr Cancer. 2005;51(1):32-6.15749627

Hollis BW, et al.  Circulating vitamin D3 and 25-hydroxyvitamin D in humans: An important tool to define adequate nutritional vitamin D status. J Steroid Biochem Mol Biol. 2007 Mar;103(3-5):631-4. 17218096

Tangpricha V, et al.  Prevalence of vitamin D deficiency in patients attending an outpatient cancer care clinic in Boston. Endocr Pract. 2004 May-Jun;10(3):292-3.15310552

Plant AS, Tisman G.  Frequency of combined deficiencies of vitamin D and holotranscobalamin in cancer patients. Nutr Cancer. 2006;56(2):143-817474859

I just feel so upset that I have been misinterpreting Hollis's paper Circulating Vitamin D3 and 25-hydroxyvitamin D in Humans and been telling people that 100nmol/l was a reasonably safe minimum. Looking again at those figures 1 and 2 I take Cannell's point that it may be better, safe rather than just stopping at 40ng 100nmol/l it may be safer, allow a bigger margin for error, to consider 50-60ng/ml 125nmo/l- 150nmol/l as the range for optimal health.
It's bad enough taking the flax and suggesting 4000iu/d is safe and reasonable where no sun exposure is possible.
I suspect I'm going to be even more unpopular suggesting 7000iu may be necessary in some/many cases.

Is there any danger from Vitamin D levels that are close to the upper ends of the 'safe' spectrum?

A study in India once linked high D levels (89 ng/mL) to  higher incidents of cardiac disease, but that study was a bit iffy.

Info can be found here: http://www.westonaprice.org/basicnutrition/vitamin-d-safety.html

Although the reference to the Indian study is buried a bit deep in that page. A lot of info there though.

What an excellent summary!

You can see that data probing the health effects, or detrimental effects of higher levels of vitamin D3 (as 25-OH-vitamin D3) are poorly explored. We aim for a blood level of 50-60 ng/ml and have observed no toxic effects whatsoever. In fact, we've observed positive effects well beyond our expectations.

Nonetheless, I think that going above 60 or 70 ng/ml is relatively uncharted territory.

http://www.vitamindcouncil.com/worst_science.shtml This summary of the Indian research mentioned earlier may help those who are unfamiliar with what is being discussed here.

The problems associated with standardisation of scores between different assessment records is complex and discussed in this paper. Serum 25-hydroxyvitamin d measurement in a large population survey with statistical harmonization of assay variation to an international standard.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17726070 There was pre-publication full text pdf version online, with some nice charts of UK vitamin d status through the year at the back, but I cannot find it now.

There is still a problem between different assay methods and lab accuracy as some of the presentations at this conference make clear.
http://app2.capitalreach.com/esp1204/servlet/tc?cn=asbmr&c=10169&s=20343&e=6950&&
The http://www.deqas.org/ system for ensuring a world standard.

While of course we must not totally turn our back on past research we do have to consider whether the levels reported would stand comparision with current standards of assessment.

While I am not suggesting that anyone should try this at home.
Safety of vitamin D3 in adults with multiple sclerosis used progressively increasing doses of vitamin D3: from 700 to 7000 microg/wk (from 28000 to 280000 IU/wk). I personally believe Vieth to be an honourable man who would, should adverse events have been record would have  reported them.
Such very high dose levels are outside of the scope of "NORMAL" vitamin D supplementation but the very fact that when tested, the results have been predictable, does give us confidence thatRisk Assessment for Vitamin D
http://www.ajcn.org/cgi/content/full/85/1/6 does stand up to scrutiny when tested.

In order to reach the levels detailed by Hollis in Circulating Vitamin D3 and 25-hydroxyvitamin D in Humans: those particularly living above latitude 37 are going to have to use more Vitamin D than Krispin Sullivan suggests during the winter months when sunlight is unavailable. It's my view that the risks associated with low vitamin d status are higher than the alleged, unproven risks of supplementing with up to 10,000iu/daily though in practice a total intake of 4000 -7000iu appear to be required during the winter when sun/uvb is not an option.

Good material on Vit D.  He mentions monthylu blood calcium tests - how critical is this test if one were supplementing in the 4000IU - 6000IU / day range?  Would Vit K2 help prevent higher blood calcium?

Monthly calcium tests are silly. There is absolutely no need for this in 99.9% of people.

No, vitamin k2 will not prevent a rise in calcium. The worry that vitamin D will raise calcium is, for the extreme majority, unfounded.

Isn't it actually possible that from a certain level of D upwards, that D keeps calcium from not only getting too low but also too high?

If your D is low I'd imagine your blood calcium would at first be high or within the upper limits of normal before going on a possible plummet route if your D drops more.

I guess once D has satisfied your bones, it doesn't over do it and distributes to other needy areas.

Will any fat (nuts) have similar results compaired to olive oil?

How often should blood tests be necessary to test vitamin-d absorption ?

Coulden't find answers to these questions using Google or Dr. Cannell's web site.

I don't know. I suspect they have some effect, but I've not examined it specifically.

We check our patients every 6 months.

While cancer is not our focus on the Heart Scan Blog, Dr. Cannell's always insightful comments provide some helpful thoughts for our management of vitamin D doses and blood levels.

DR Carnell im a huge fan of you and i know ur very smart and good at what u do and love to help educate people about there health expecially about vitamin d i am 28 years old 290 pounds 5 foot 10 vitamin d defient and have severe hypertention i take tribenzor 40-10-25 mg's in the am and monopril 20mg's in the pm, and b12 sublingual which works wonders for me mentally well anyways since iveb been taking bob barefoots coral calcium and vitamin d 3 my blood pressure went from 125 70 to 88/37 i felt like crap i stopped the tribenzor 40-10-25mg pill and increaded the monopril to 30 mg;s my pressure has been 126/60 im feeling a feverish warm feeling i wonder if its the vitamin d 3 or coral calcium or too much b12 or could it be the withdrawals of tribenzor is a cobination drug 3 pills in one for hypertention i took alil less then half a pill of the tribenzor and the fever hot flashes went away my doctor already told me that vitamin d doesnt lower bloodpressure so what should i do and what should i say to him i have an appointment the 25th of october for a bloodpressure check up.  Please help me fit the batlle of hypertention and give me ur honesy opinion thanks doc god bless u were put on this earth to help people like me thnak you.  Just wanted to let u know im taking about 5,800 ius a day thank you.and also when i stop the monopril ive had heart fluttering ive done it before, been on it since i was 16 years old.

Nice sight - I've enjoyed checking it out the last few days and expect that I'll make it a regular stop by to see the author’s latest writings.  

It is outside of nutrition but in particular liked reading about LED lights.  I ordered a few of them.

Wow!  This is an incredible conflict of interest!!  No wonder I have felt so much pressure to do this and that despite never being sick and having no symptoms.  

How did medicine get to this point?  The better question is 'How can doctors live with themselves?'  

We all know that everyone has to earn their living but but this milking of the system and of patients is truly horrible! It is especially insidious when you are dealing with someone you need to trust implicitly and who tells you that you need to do these things because he/she is worried about your health!

I thought you might be interested in this article on a physician in Arizona who is remodeling his practice to offer concierge health care.
http://www.azcentral.com/business/articles/2008/07/23/20080723biz-elitedocs0724-ON.html
As an advocate of free market solutions, I will be looking for a physician in my area with the same philosophy.  But I don't really expect to find one, as I am in an area dominated both by a State University Health System, and a Private University Health System. My own PCP is in the private University system.  We are asked to sign arbitration agreements with the University in case of  some untoward event (I refused, but I believe many patients believe they must either sign or go untreated, or else do not realize what they have signed.) Now the system has implemented a program that is ostensibly designed to help patients develop preventive health practices.  You are provided a liason person ( a nurse I assume) to check in with once/month by phone,and in that conversation you are asked about your goals and what you're doing to reach them, and given the usual status quo, conventional advice about concerns.  (This person will never even set eyes on you, after all.)   Still, it  doesn't sound bad, even sounds as if they are making genuine if nonsubstantive efforts toward helping people be proactive.  But I would not be surprised if the whole scheme were somehow rigged to the advantage of the University insurance plan, such as being enabling them to see if you are receiving more treatment (such as seeing an acupuncturist or chiropractor) than "they" think is appropriate or taking only the drugs "they" approve, and I also suspect that one day it will no longer be voluntary, and that you will be coerced toward only the practices they approve of.  Why are they offering payments for participation, is my question, and what do they do with the information you give them?  I will be opting out of that too.

As far as free market solutions and the concierge model go, many will argue that it is too expensive and will only provide care for an elite.  The Arizona physician will charge a flat fee of $1500/year, and that will entitle his patients to direct access to him by phone or email, and at least 30 minutes of his time per visit.  His practice will have to be smaller than in the past in order for him to give more to each patient, but he will be able to actually practice medicine rather than be a cog in a corporate machine. Surely there are free market models that can be devised for the average person as well.  To object that the cost of modern health care is prohibitive may be simplistic.  Why is it prohibitive?   Can it be because the market does not function freely under the triple chokehold of insurance, drug company and government collectivism?    If patients and physicians were able to devise alternatives to the present environment of health care and PARTICULARLY if true, effective preventive practices (and many are already available at nominal cost but not promoted) became the norm, costs could plummet.  Hail to the pioneers such as Dr. Davis and the TYP members, and to the Arizona Concierge physician, who are striking out for new territory.  We will all benefit tremendously.

Dr. Davis,

Your fellow cardiologist Rich Fogoros also addressed this breakdown of the role of doctor as advocate, but he argues just the opposite: that PCPs today are essentially employees of the health insurance companies, tasked with controlling costs by minimizing tests, procedures, specialist referrals, etc., like claims adjusters.  His version certainly seems to be more true where I live.  I can't speak to the extent to which my PCP is under pressure to stay within a quota (however informal) for monthly rheumatologist referrals, CT scans, etc., or the degree such pressure taints his patient interactions, but I do know that he works in a clinic owned by the same (insurance) company to whom my employer and I pay my premiums, and that the same company also owns the local hospitals.  Clearly the profit-maximizing thing in such case is to maximize (healthy) policyholders and minimize claims (treatment).  There's no profit in gratuitous caths and bypasses when the hospital is the insurance company.  Fogoros claims that this sort of vertical integration became the rule when the HMOs bought up all the community hospitals and clinics in the late '90s.  A friend of mine (under my same plan) suffered a nasty GI tract problem and had to beg and fight her PCP, over 2-3 months of almost constant vomiting and other fun, for a referral to a gastroenterologist, who did finally diagnose and cure her.  The PCP was clearly in over his head, yet kept futilely giving her the same garden-variety pills (antiemetics, PPIs, etc.) and at one point told her, "Look, I can't just send everybody to the GI to have him say, 'Take the Purple Pill!'"  So Fogoros' "covert rationing" seems to go on in my town.  Can you reconcile that with what you're saying?

All my adult life I've been told by doctors I have "borderline hypertension" (about 140/90). None, however, ever even suggested that I take an anti-hypertensive. Now I have atherosclerosis and can but wonder what might have been. Let mine be a cautionary tale.

Not all insurance plans require a person to go through the PCP for referral to a specialist. I have seen patients who are seeing multiple specialists where it seems no one is in charge of the overall picture. These people may be given duplicate tests and incompatable medications. Doctors don't always communicate with each other. Shouldn't there be one chart that follows the patient from doctor to doctor?

When I was seeing a university PCP I found it difficult to get tests such as vitamin D, B12 and A1C.
Anne

Practicing primary care in the US in the current environment is incredibly challenging, but still very rewarding. As an employed family physician in Massachusetts, I am pulled in many competing directions: the hospital encourages referrals and admissions into the system the patient's insurance company discourages some referrals and limits access to certain medications and expensive tests.  There is more paperwork and bureacracy than ever.  Patients are more informed now, and often come in with information, some of which literally may be based on one person's opinion from a website or blog.  There are often many issues to try to sort through in one visit, a visit which is often limited by time pressure that exist as doctors try to see more and more patients.

Despite this, I still feel it is a privilege to be chosen as someone's family doctor.  I tell my patients that I will try to treat them like my family and give them the same advice I would give my mother or my daughter.  I see my role as their guide, and I try to lay out the different options, and then tell them which one I would personally choose, but that it is ultimately their body, and they get to make the decisions.

What it comes down to for me is that medicine is still about the interaction between the doctor and the patient, and if a patient is unhappy with that interaction, then they have the right to try to find a new doctor where they will feel cared for.

I had to also respond to Jenny's post about concierge medicine.  It is definitely an attractive option for some patients and physicians.  I once read it explained like this: "Imagine you're a plumber, and someone says I will pay you more money to do fewer plumbing jobs, so you can spend more time on each job, and really focus on doing the highest quality work you can, really get back to what it was that drew you to being a plumber."  Who wouldn't want that?  My problem is that it is not extrapolable.  If a primary care concierge physician only has 300 patients, there is going to be a huge shortage of primary care doctors in this country.  My training in both medical school and residency was oriented around taking care of all the patients that needed help, not just the few hundred that could afford an annual fee of several thousand dollars a year.

There is a group of doctors who have come together in Seattle to practice medicine in a very intriguing model.  It is called Qliance (www.qliance.com).  It has some similarities to a concierge practice, but is much more affordable.  They don't take insurance, there are direct monthly costs that are charged to the patient which covers unlimited visits.  Additional tests are paid for by the patient.  This model financially aligns the patient and physician, and the usually-hidden costs of medicine are out in the open.  One physician who works there described it as very refreshing to feel that you are really working for the patient.  It won't be the answer for everyone, but it may be the answer for many.

Anne posted that some patients are seeing multiple specialists without having a primary care doctor.  

That's my predicament, and I wish it weren't so.  As an 57 year old woman with multiple annoying health problems including diabetes, hypertension, and some difficult-to-treat chronic pain (chronic daily migraine, neck problems), I can't find a PCP who will stick with me: They are apparently so unnerved by the list of maladies that I must deal with that they decide I must be crazy, not ill, and stop working on my behalf.  

I just hate trying to be my own PCP!  I'm terrible at it!  The idea of having a PCP who would help me manage all this stuff is a dream!  And I haven't had a physical in over a decade because I can't keep a PCP.  And although my specialists kindly try to fill that gap in my treatment, I know that not having a PCP is dangerous.

However even with my excellent insurance and ability to pay and living in an area with an unusually high number of doctors/capita, apparently I fall into a category of patient that PCP's just can't deal with.

Yes, I saw the McDougall post, too, and I also thought his fictitious  conversation was in very poor taste, not to mention very misleading and unhelpful in terms of what people could learn about avoiding a similar fate.

It's not that we can't review and learn from what happened (and didn't happen) in Mr. Russert's case, but it's important to be factual and make sure it will actually teach something useful, not to mention not cross the line of good taste.

Dr. Davis, I think there is a mile of difference in the way you refer to Mr Russert's untimely passing, with thoughtful commentary on what we can learn from this prominent example.  

But Dr. McDougall's "posthumous interview" post, on the other hand, is nothing more than tacky self-promotion and yet more misleading vegetarian propaganda.

I found a great book about Tim Russert at Walgreens.  It has stories from the people that knew him.  It sounds like he liked his beer.  I wonder if beer helped or hurt his condition.  Anyway, there is sample chapter of the book at:
http://www.timrussertbook.com/

I found a great book that very few people probably know about.  The book is called "Tim Russert: We Heartily Knew Ye" and it contains stories from people that knew Tim. The book is only sold in Walgreens and they even have a sample chapter on the web at:
http://www.timrussertbook.com/
Tim seemed to like beer a lot.  I wonder if it helped or hurt his condition?

McDougall did something similar with Bill Clinton regarding his bypass surgery. Link:

http://www.drmcdougall.com/misc/2008nl/apr/letters.htm

I was a McDougall follower for years.  Now I have virtually no respect for the guy.  I was probably the fatest vegan you've ever met.  Could not get below 190 pounds, was hungry all the time, skin was dry and cracked,  hair was like a Brillo pad, and blood sugar was rising.

He has nothing to offer a diabetic or anyone with metabolic syndrome.   I think initially people see change on his diet, but long term I didn't seem to benefit.

Russert also had the bulging eyes and thinning eyebrows of the untreated low-thyroid sufferer.

But the McDougall post on Russert was beyond the pale.

Same old!  Russert, I am sure, did NOT eat a low fat/high carb diet.  Low fat means for sure, less than 15% and more like 10% calories from fat and near 80% from carbs.  Most research and studies etc call 25% or even 35% low fat!  That is HIGH fat AND high carb which is definitely a deadly combo, just a more toxic version of SAD because undoubtedly, in trying (and failing) to go low fat, he was eating lots of manufactured, fake, food like substances that were loaded w/ transfats and chemical preservatives, dyes (note the inadvertent homonym pun), etc.  He died of misplaced, good intentions that were aborted by faulty education and industry PR, but definitely not a low fat diet!

The bulging eyes are a sign in hyperthyroidism - over-active thyroid.