Vitamin D for Peter, Paul, and Mary

Why is it that vitamin D deficiency can manifest in so many different ways in different people? One big reason is something called vitamin D receptor (VDR) genotypes, the variation in the receptor for vitamin D.

It means that vitamin D deficiency sustained over many years in:

Peter yields prostate cancer

Paul yields coronary heart disease and diabetes

Mary yields osteoporosis and knee arthritis.


Same deficiency, different diseases.

VDR genotype-determined susceptibility to numerous conditions have been identified, including Graves' thyroiditis, osteoporosis and related bone demineralization diseases, prostate cancer (Fok1 ffI genotype), ovarian cancer, rheumatoid arthritis, breast cancer (Fok1 ff), birth weight of newborns, melanoma and non-melanoma skin cancers, insulin resistance and metabolic syndrome, susceptibility to type I diabetes, Crohn's disease, and neurological or musculoskeletal deterioration with aging that leads to falls, respiratory infections, kidney cancer, even periodontal disease.


Why is it that the dose of vitamin D necessary to reach a specific level differs so widely from one person to the next? VDR genotype, again. Variation in blood levels of 25-hydroxy vitamin D from a specific dose of vitamin D can vary three-fold, as shown by a University of Toronto study. In other words, a dose of 4000 units per day may yield a 25-hydroxy vitamin D blood level of 30 ng/ml in Mary, 60 ng/ml in Paul, and 90 ng/ml in Pete--same dose, different blood levels.

Should we all run out and get our VDR genotypes assessed? So far the data have not progressed far enough to tell us. If, for instance, you prove to have the high-risk Fok1 ff genotype, would you do anything different? Would vitamin D supplementation be conducted any differently? I don't believe so.

Virtually all of us should be supplementing vitamin D at a dose that generates healthy blood levels, regardless of VDR genotype. For those of us following the Track Your Plaque program for coronary plaque control and reversal, that means maintaining serum 25-hydroxy vitamin D levels between 60-70 ng/ml.

As the fascinating research behind VDR genotype susceptibility to disease unfolds, perhaps it will suggest that specific genotypes be somehow managed differently. Until then, take your vitamin D.

Comments (15) -

  • Kiwi

    3/27/2009 8:48:00 PM |

    I've been taking vitamin D for about five months now after reading Dr. Davis' excellent blog.
    Was taking two Thompson's D 1000 caps/day. Latest test result for 25 hydroxy came back at 142 nmol/l so have cut back to one cap/day. So yes, dose depends on body type and sun level (summer here).

  • Kiwi

    3/27/2009 9:00:00 PM |

    I've just done the conversion to ng/mL. Is that by dividing by 2.5? Perhaps I should keep up the two caps/day?

  • Dr. William Davis

    3/27/2009 10:39:00 PM |

    Yes. 142 nmol/L = 56.8 mg/dl.

  • Monica

    3/28/2009 1:41:00 AM |

    Thanks for blogging on this, Dr. Davis.  I just got my test for the first time and was alarmed that I came in at only 30 ng/mL after supplementing with 1000 IU daily for about a year.  I had previously lived in Syracuse, NY, the cloudiest city just behind Seattle.  And on a grain-based crap diet, too.  No longer.  Here's my vitamin D story:  http://sparkasynapse.blogspot.com/2009/03/vitamin-d-results.html

    I've been wheat-free for 9 months now, but this makes me really curious about my lipid profile...  I still have a ways to go to reach optimum health.  I'm only 34 so hopefully plenty of time to correct this problem.  Unfortunately for my older relatives they were not so lucky.  Cancers, diabetes, heart disease abound.

  • Anonymous

    3/28/2009 5:58:00 AM |

    Have you any comment on this:
    http://www.cholesterol-and-health.com/Vitamin-D.html

  • Peter Silverman

    3/28/2009 10:28:00 AM |

    Article in yesterday NY Times regarding high doses of D3 protecting against fractures:
    http://www.nytimes.com/2009/03/31/health/research/31aging.html?ref=health
    Unfortunate that the title says pills not capsules.

  • Anonymous

    3/28/2009 5:17:00 PM |

    I was also very shocked with my vitamin d test results. After 5 months @ 6000iu daily my level was only 34 ng/mL. It is winter but I work outside and seldom use suncreen.

  • Anonymous

    3/28/2009 9:34:00 PM |

    The Toronto study suggests there are polymorphisms of the D-binding protein. Isn't this a separate entity than VDR, which is present on cellular surface in many tissues? Maybe I am misunderstanding something ....Thomas

  • Ricardo

    3/28/2009 10:46:00 PM |

    Dr. Davis, should runner's use some suncreen? I was reading this article and decided to ask here: http://dailyviews.runnersworld.com/2009/03/i-will-never-ev.html

  • Kismet

    3/29/2009 11:12:00 AM |

    As the evidence currently stands everyone should wear sunscreen *and* supplement vitamin D. (benefits of red & blue light can be had without dangerous UVR)

  • rabagley

    3/29/2009 9:56:00 PM |

    Basically, we should all be getting full-spectrum sunlight in moderate amounts.  Moderate means that you have browning or slight reddening of the skin (if you're still red the next day, that was too much).  This does increase your risk of carcinomas (a low risk type of cancer), but minimizes your risk of melanomas (an extraordinarily high risk type of cancer).  Repeated sunburns increases your risk of melanoma and should be avoided if at all possible.

    As a runner, it's often difficult to control the length of time you spend in the sun to moderate your exposure.  The length of time you spend running will usually have more to do with your exercise goals than your sun-exposure goals.  This means that you will most likely not be able to maintain moderation and would put yourself at increased risk of dangerous cancers.

    So starting from a completely different set of assumptions, I reach the same conclusion as Kismet, that you should probably be wearing sunscreen and supplementing with Vitamin D3 gelcaps.

  • TedHutchinson

    3/30/2009 11:22:00 AM |

    Ricardo

    Skin Cancer/Sunscreen - the Dilemma

    and everyone else will benefit from  watching the Edward Gorham's video or if time is short at least look at the slides used in his presentation
    Skin Cancer/Sunscreen -- the Dilemma slides PDF
    No one should ever allow skin to burn. Prolonged UVB exposure   processes any vitamin d near the skin surface into suprasterols that are not usable, so alternating short sun sessions with time for the skin to cool down and Vitamin D to be absorbed will optimize the process.

  • Rick

    4/2/2009 7:11:00 AM |

    This lecture is entertaining and informative:
    Vitamin D

  • Anonymous

    4/6/2009 10:34:00 PM |

    I have always purchased Vitamin D3 from fish oil but discovered while shopping this weekend that there is also a Vitamin D3 obtained from 'wool' or 'lanolin'.  I had never seen this before.  Which is preferable? from fish oil or from lanolin?

    thanks,
    nancy

  • Anonymous

    4/10/2009 6:24:00 PM |

    Can someone list the effects of overdosing on D3?

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Super-carbohydrate

Super-carbohydrate

Wheat starches are composed of polymers (repeating chains) of the sugar, glucose. 75% of wheat carbohydrate is the chain of branching glucose units, amylopectin, and 25% is the linear chain of glucose units, amylose.

Both amylopectin and amylose are digested by the salivary and stomach enzyme, amylase, in the human gastrointestinal tract. Amylopectin is more efficiently digested to glucose, while amylose is less efficiently digested, some of it making its way to the colon undigested.

Amylopectin is therefore the “complex carbohydrate” in wheat that is most closely linked to its blood sugar-increasing effect. But not all amylopectin is created equal. The structure of amylopectin varies depending on its source, differing in its branching structure and thereby efficiency of amylase accessibility.

Legumes like kidney beans contain amylopectin C, the least digestible—hence the gas characteristic of beans, since undigested amylopectin fragments make their way to the colon, whereupon colonic bacteria feast on the undigested starches and generate gas, making the sugars unavailable for you to absorb.

Amylopectin B is the form found in bananas and potatoes and, while more digestible than bean amylopectin C, still resists digestion to some degree.

The most digestible is amylopectin A, the form found in wheat. Because it is the most readily digested by amylase, it is the form that most enthusiastically increases blood sugar. This explains why, gram for gram, wheat increases blood sugar to a much greater degree than, say, chickpeas.

The amylopectin A of wheat products, “complex” or no, might be regarded as a super-carbohydrate, a form of highly digestible carbohydrate that is more efficiently converted to blood sugar than nearly all other carbohydrate foods.

Comments (18) -

  • Jim Purdy

    5/22/2010 3:30:00 PM |

    QUOTE:
    "... gram for gram, wheat increases blood sugar to a much greater degree than, say, chickpeas. "

    Well, that ain't good.

  • David

    5/22/2010 4:21:52 PM |

    I've really enjoyed these last couple of posts about wheat. Very informative and accessible. Thanks for taking the time to make this kind of info available to the wider audience.

    David

  • Anonymous

    5/22/2010 5:12:17 PM |

    fascinating

  • pjnoir

    5/22/2010 8:48:14 PM |

    WOW- a classic lose-lose. 25% remains in your colon, to become a bacteria feast and the rest (75%) increases blood sugar and insulin production to store it as a fat cell.  hmmmmm, thank goodness for science, we may save ourselves.

  • Anonymous

    5/22/2010 10:15:53 PM |

    Dr. Davis,

    While not on a directly related note, do you have any general feelings on moderate consumption of buckwheat as a carbohydrate source? From what I have read, this "pseudo" grain seems to be far less problematic than true grains. It would still not give most folks a license to consume it ad libitum, but I am curious if you'd consider this a decent choice in controlled amounts (with the actual amount varying by context and the overall health of the person in question).

    -Dave Balon

  • Mike

    5/22/2010 10:37:12 PM |

    Excellent explaination, Dr Davis.

  • Anonymous

    5/23/2010 1:55:46 AM |

    I'm really enjoying your posts about wheat.  Very interesting.  Thanks

  • Apolloswabbie

    5/23/2010 3:27:45 PM |

    Thank you Dr. D

  • Jill

    5/24/2010 3:04:47 PM |

    Dear Heart Scan Blog,

    I am a student at the  University of Rochester working on an internship project in conjunction with RateADrug.com to collect primary user data about side effects and benefits from commonly used treatments for Atherosclerosis & Arterial Disease.  The goal is to build a large, public access database of unbiased, anecdotal data about Atherosclerosis & Arterial Disease treatments.

    We want to let both patients and practitioners know about how they can participate in or benefit from the project.  Users can add their experiences with a treatment and learn more about how the treatment is affecting them by taking a short, confidential survey. They can also use RateADrug to compare aggregate data for different Atherosclerosis & Arterial Disease treatments- both conventional and alternative (http://www.rateadrug.com/Atherosclerosis-and-Arterial-Disease-symptoms-feedback.aspx) - and forward the results of their own surveys to their doctors or family members.

    Rateadrug is an independent data gathering and information website that does not accept funding or advertisement from drug companies.

    Would it be possible for you to make this information available to your viewers so they can help us collect important data on Atherosclerosis & Arterial Disease treatments?

    Thank you in advance. I'd be happy to speak with you if you have any questions or comments.

    University of Rochester
    www.RateADrug.com student intern
    jillian@radpprep2.com

  • Dr. William Davis

    5/24/2010 10:28:41 PM |

    Hi, Paul--

    Yes, indeed. The data relating high-carbohydrate intake with multiple forms of cancer is getting very scary.

  • Anonymous

    5/25/2010 4:18:17 AM |

    Wow, I am a long time fan of heartscanblog, but Paul's citation is the most misleading EVER.   The authors found that carbs were associated with pancreatic cancer only in the FIRST FOUR years of follow-up, whereas fat and saturated fat were associated with pancreatic cancer during follow-up GREATER than four years.  Since pancreatic cancer takes years to develop, the authors conclude that carbohydrates are NOT CAUSAL to pancreatic cancer - fat may be.

  • DrStrange

    5/25/2010 2:43:32 PM |

    "The data relating high-carbohydrate intake with multiple forms of cancer is getting very scary."

    I would think at least in part from the higher blood sugars.  Much less problematic w/ whole, intact grains (boiled vs ground into flour and refined (and then higher temp. baked or fried)!

  • discombobulated

    5/25/2010 7:50:36 PM |

    I love your blog.  We have switched out diets to something much closer to what you recommend due to the fact that my husband's psoriasis gets so much better if he avoids wheat,potatoes, corn, refined sugars, and dairy.  We figure it's better than using steroids for the problem.  We also have one son who has been biopsied for celiac after is blood work and we were told he doesn't have the correct atrophy but does have a damaged intestine.  

    So we are committed to eating this way.  But one thing I have wondered about is if you feel that carb blockers work for blocking starch.  There are times when I would kill for a baked potato but try not to because it starts a negative cycle.  And now I know that it's not so hot for my heart either.  

    This post made me wonder if there isn't some merit in them.

  • Breast Augmentation Los Angeles

    5/26/2010 6:20:52 PM |

    Thanks for discussing this.I thought whet is sort of better than the white bread for the diabetic and the heart patients.

  • best pharmacy

    12/7/2011 11:28:22 PM |

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  • best pharmacy

    12/7/2011 11:28:46 PM |

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  • Mary Wier

    7/10/2012 8:38:03 AM |

    Bill and I found our Wheatbelly book and have been off gluten for 9 months, it was hard at first but we now
    feel so different, Bill's blood sugar dropped 25 points, and we look at all our food so differently now!
    The display of wheat rolls and pastry at our buffet looks more and more like hidden poison.
    We are off sugar, too it is so tempting but our body says, Thank you Dr. Davis!

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