Annual Patient Workshop

Treating

Autoimmune and

Inflammatory

Diseases with

Inflammation

Therapy

When: Sunday

February 16, 2014

Where: Hilton

Dallas-Ft. Worth

Lakes Executive

Conference Center

For details and

registration 

information

click here

Therapy Tip

 CIR is an IRS-recognized 501(c)3 non-profit charitable organization. 

Donate to CIR

 in support of our educational and research efforts. 

If you meet these criteria and would like to take part in this project (which will only take a few minutes each month), please contact us at our email address.  

Greetings,

Chronic Illness Recovery often gets calls from frantic, discouraged patients who are desperate for help. It gives us a wonderful feeling of satisfaction when we can help them. Whether they need direction, encouragement, information or all of those, we are happy to help. That's one of the reasons CIR exists. We are here to teach, support, encourage and offer hope.

We couldn't carry on without the generous financial support of our contributors. Since this is the time of year when most of our contributions come in, we thought you would like to know some of our accomplishments.

We have held two physician seminars offering continuing medical education credits and we are finalizing plans for the next one, to be held February 15 near the Dallas-Fort Worth airport.

Our annual Patient Workshop is always heartwarming, as we meet patients and their families from all over the country. The day is full of informative presentations and there is time to share experiences and learn from each other. Our third Patient Workshop will be held Feb. 16 in the Dallas-Fort Worth area.

At any given time, we have around 50 patients in our counseling service, where we work with patients between visits to their medical practitioner. As a charitable organization, about half of our counseled patients pay nothing at all or pay a reduced fee (based on income and size of household) for these services.

We maintain an up-to-date library of information on our website. Some of our articles are available for the public, while others are reserved for registered members only. These are useful for reading as time permits but we also use them to point patients to the information they need to understand the disease process as well as how they can manage symptoms and recovery.

Please remember CIR as you make your gift-giving plans. You can't find any other group more diligent and dedicated to helping others. Donations of any size are appreciated and put to good use.

Risks of Vitamin D Supplementation

More vitamin D experts are beginning to reconsider vitamin D supplementation among the general population. [1] In the Leiden Longevity study, low levels of 25-D cast doubt on the causal nature of previously reported associations between low levels of vitamin D and age-related diseases and mortality. [2] A 2009 study found that depressive symptoms were not associated with low vitamin D and researchers have expressed concern that high vitamin D levels in pregnancy and at birth may contribute to a higher risk for food allergy in children. [3, 4] Recommending higher vitamin D intake to large populations carries the potential risk of overdosing certain individuals; for example, vitamin D supplementation increased mortality among institutionalized elderly women. [5]

In fact, excessive vitamin D can be toxic to humans and to animals. This is dramatically illustrated in the use of rodenticides with high vitamin D content (e.g., True Grit Rampage & Ortho Rat-B-Gone) and when livestock die following ingestion of plants that contain derivatives of vitamin D metabolites (e.g., cestrum diurnum and solanum malacoxylon). [6, 7] DeLuca et al. [8] concluded that 25-D is the metabolite responsible for vitamin D toxicity. The immediate effects of significant vitamin D toxicity (hypervitaminosis-D) are hypercalcemia, hypercalciuria, bone resorption, and calcification of soft tissues. In humans, symptoms of hypervitaminosis-D depend on the patient's condition and the level of excess vitamin D metabolites; people with high blood calcium or phosphorus levels, heart problems, kidney disease, sarcoidosis, and tuberculosis are at highest risk. [9] It is difficult to ingest too much vitamin D from food, and natural mechanisms regulate the amount of vitamin D3 photosynthesized from sunlight; within about 20 minutes of ultraviolet exposure in light-skinned individuals (3-6 times longer for pigmented skin), the concentrations of vitamin D precursors produced in the skin reach an equilibrium, and any further vitamin D that is produced is degraded. [10] However, elevated 25-D and hypervitaminosis-D can occur due to vitamin D supplementation. [11]

Researchers are beginning to realize excessive vitamin D intake may cause problems. Muhammad Amer, M.D., an assistant professor in the division of general internal medicine at the Johns Hopkins University School of Medicine, said "People taking vitamin D supplements need to be sure the supplements are necessary. Those pills could have unforeseen consequences to health even if they are not technically toxic." [12] When cancer studies (breast and colorectal) from the Womens' Health Initiative, showed no protective effects of vitamin D supplementation, the researchers suggested the dose of vitamin D might have been too low. However, the results of the studies actually showed trends toward potential harmful effects of high vitamin D intake. [13] Researchers like Dr. Anja Olsen are concerned that the discussion on potential negative effects of vitamin D supplementation (besides those of toxicity) is very limited. "...the past has shown us (with the history of β-carotene and lung cancer as the scariest lesson) that observational studies on micronutrient blood levels cannot always be extrapolated to positive effects of high-dose supplementation." [14] Cases such as these remind us that some therapies which seemed to show promise for treating or preventing health problems ultimately did not work out and even caused harm. Emerging evidence about an intervention should be approached cautiously and with an open mind.

Dr. Michael J. Glade believes 25-D may appear to be low for reasons totally independent of sunlight exposure or vitamin D intake. He expresses concern that local tissue vitamin D intoxication may be present in individuals with much lower serum 25-D concentrations than are currently appreciated and that prolonged routine consumption of megadoses of vitamin D may interfere with the regulation of phosphate homeostasis by fibroblast growth factor-23 (FGF23) and the Klotho gene product, with consequences that are detrimental to health. [15] This 1983 study sounded an early alarm,

The requirement for vitamin D is normally met by its synthesis in the skin. In the United States, various foods are fortified with vitamin D to ensure that deficiencies do not occur. As a result, most individuals consume and synthesize more vitamin D than they require. As most individuals appear to be at risk of obtaining too much vitamin D rather than too little, we suggest that fortification of foods with vitamin D should be curtailed, preferably abolished, that excessive fortification of animal foods be reduced to the level required, and that the use of dietary supplements be restricted. Populations at risk could be monitored closely and counseled to prevent vitamin D deficiency. [16]

The Institute of Medicine (IOM) has shifted the paradigm from thinking about 'more is better' to a more risk-averse approach. [17] It has also challenged the notion that harm should be viewed in terms of vitamin D toxicity such as hypercalcemia, hypercalciuria, or metastatic calcification. It has advanced the concept of 'harm' in terms of chronic disease outcomes and mortality.[18] Because adverse effects of vitamin D supplementation may take decades to be realized, clinicians (mindful of the medical ethics precept "First, do no harm") should err on the side of caution; follow the IOM guideline and wait for the results of long-term vitamin D studies.

References 

1. Tseng L. Controversies in Vitamin D Supplementation. eScholarship. 2003.http://www.escholarship.org/uc/item/4m84d4fn#page-1. Accessed May 7, 2013.
2. Noordam R, de Craen AJ, Pedram P, et al. Levels of 25-hydroxyvitamin D in familial longevity: the Leiden Longevity Study. CMAJ. Dec 2012;184(18):E963-8.
3. Pan A, Lu L, Franco OH, Yu Z, Li H, Lin X. Association between depressive symptoms and 25-hydroxyvitamin D in middle-aged and elderly Chinese. J Affect Disord. Nov 2009;118(1-3):240-3.
4. Weisse K, Winkler S, Hirche F, et al. Maternal and newborn vitamin D status and its impact on food allergy development in the German LINA cohort study. Allergy. Feb 2013;68(2):220-8.
5. Bjelakovic G, Gluud LL, Nikolova D, et al. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev. Jul 2011;(7):CD007470.
6. Krook L, Wasserman RH, McEntee K, Brokken TD, Teigland MB. Cestrum diurnum poisoning in Florida cattle. Cornell Vet. Oct 1975(65(4)):557-75.
7. Boland RL. Solanum malacoxylon: a toxic plant which affects animal calcium metabolism. Biomed Environ Sci. Dec 1988;1(4):414-23.
8. DeLuca HF, Prahl JM, Plum LA. 1,25-Dihydroxyvitamin D is not responsible for toxicity caused by vitamin D or 25-hydroxyvitamin D. Arch Biochem Biophys. Jan 2011;505(2):226-30.
9. Vitamin D Overview. University of Maryland Medical Center. 2011. Available at: http://www.umm.edu/altmed/articles/vitamin-d-000340.htm. Accessed May 8, 2013.
10. Holick MF. Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr. Mar 1995;61(3 Suppl):638S-645S.
11. Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr. May 1999;69(5):842-56.
12. Amer M, Qayyum R. Relation between serum 25-hydroxyvitamin D and C-reactive protein in asymptomatic adults (from the continuous National Health and Nutrition Examination Survey 2001 to 2006). Am J Cardiol. Jan 2012;109(2):226-30.
13. Neuhouser ML, Manson JE, Millen A, et al. The influence of health and lifestyle characteristics on the relation of serum 25-hydroxyvitamin D with risk of colorectal and breast cancer in postmenopausal women. Am J Epidemiol. Apr 2012;175(7):673-84.
14. Olsen A, Egeberg R, Tjønneland A. Re: Calcium Plus Vitamin D Supplementation and the Risk of Breast Cancer. Journal of the National Cancer Institute. May 6, 2009. http://jnci.oxfordjournals.org/content/early/2009/04/28/jnci.djp065.full. Accessed May 8, 2013.
15. Glade MJ. Vitamin D: health panacea or false prophet? Nutrition. Jan 2013;29(1):37-41.
16. Holmes RP, Kummerow FA. The relationship of adequate and excessive intake of vitamin D to health and disease. J Am Coll Nutr. 1983;2(2):173-99.
17. Ross AC, Manson JE, Abrams SA, et al. The 2011 Report on Dietary Reference Intakes for Calcium and Vitamin D from the Institute of Medicine: What Clinicians Need to Know. J Clin Endocrinol Metab. Jan 2011;96(1):53-58.
18. Ross AC, Taylor CL, Yaktine AL, Del Valle HB. Dietary Reference Intakes for Calcium and Vitamin D. Washington, D.C.: National Academy of Sciences; 2010. 0-309-16394-3.

"Thanks to all for your help in understanding my symptoms and my IT dosage!" Kathy H.

"It has been a great help being part of the CIR community.  I think, even though I've had a hard time of it, the process has been smooth with the help of the knowledgeable staff.  The community of support from the other members has been great at times for me too." Jean