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Chronic Illness Recovery Newsletter

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Workshop May 19 
 NYC  

 Meg will be in NYC to  

present a poster at the American Society of Hypertension 
Annual Scientific Meeting and Exposition. 
She will host an informal get-together Monday afternoon, May 19 at the midtown Hilton and would 
love to meet you. 
Please RSVP by email


 


Seminar

Presentations  

 

To obtain a flash drive with  
the PP slides of the 2014 Physician Seminar presentations, please send  
your full name and street mailing address to The payment of $10 may be made online at this link or
sent to
P.O. Box 10756,
Fort Worth, TX 76114.

 

  

 

Therapy Tip

 

Serum samples for measuring 1,25(OH)2D should be frozen for transport to the testing lab. This precaution limits agitation of the specimen during shipping and prevents degradation of this vitamin D metabolite. Results that are below 20 pg/mL (or lower than expected given the clinical picture) suggest mishandling of the sample.


 

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(toll-free in the US and Canada).  

    

 

Recovery Reports

 

To see our latest recovery 

reports click here

 

If you have recovered your health or had significant symptom improvement with Inflammation Therapy (or a similar treatment), please  

help us 'pay it forward' by  

telling your story.  

Any report, short or long,   

with or without objective data (e.g., lab results, imaging reports) would be helpful.   

 

Please email your story.

Thank you!  

 

 

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Please email for a  

request to access. 

 

   

 

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Issue: 54
May 2014


Greetings!   

We invite you follow Meg on Twitter @occultinfection and our facebook Chronic Illness Recovery page for daily info on the science about autoimmune and inflammatory diseases.  These are exciting times to network with physicians and patients worldwide.  Meg continues to travel within the USA meeting with professionals and patient workshop groups to discuss the details of treatment.  One is scheduled this Monday May 19 in the NYC midtown Hilton.  Contact her at the CIR email to join the discussion.
Soon it will be second nature to assess our inflammation load and prevent and manage chronic illness for a full and functioning life.  While science no doubt will tease out the molecular actions of nature and man-made sources of epitope spread in our diverse immune system, today we have a window to view a dysregulated vitamin D endocrine system...the system keeping our microbial partners in check.  

 

~ your CIR team

About Inflammation Therapy
 

Diagnosis of Dysregulated Vitamin D Metabolism


Chronic inflammation is associated with a range of unhealthy aging phenotypes and a decreased likelihood of successful aging. [1] For example, Phillips et al. [2] found that individuals who were metabolically healthy had lower serum levels of inflammatory markers compared with their non-metabolically healthy counterparts. Assessing vitamin D metabolites and diagnosing dysregulated vitamin D metabolism has the potential to guide clinical practice. Vitamin D status is currently determined by measuring the level of 25(OH)D which, presumably, reflects the levels of other vitamin D metabolites (e.g., vitamin D3, vitamin D2 and 1,25(OH)2D, etc.). This measurement may not, however, provide enough information to assess vitamin D endocrine function. Although 25(OH)D is the major circulating metabolite of vitamin D and the form most often assessed clinically, it is the active 1,25-dihydroxylated form of the hormone that is responsible for its biological effects. The clinical utility of measuring 1,25(OH)D is not fully understood, but it is clear that associations are being made between this active metabolite of vitamin D and disease states.[3, 4] Measurement of both the active metabolite and its precursor is essential to diagnose dysregulated vitamin D metabolism; assays of 1,25(OH)2D and 25(OH)D provide valuable tools to assess inflammation in chronically ill patients. [5] Vitamin D status encompasses more than vitamin D intake; 1,25(OH)2D formation isn't directly regulated by parental vitamin D and it may be affected by the same factors that cause a decrease in serum 25(OH)D.

 

Currently, 1,25(OH)2D is not being used as a measure associated with vitamin D nutritional status or as an intermediate marker related to health outcomes, or even routinely assessed in vitamin D research. In the context of solving the puzzle of vitamin D deficiency, the reasons cited for this lapse fail to consider the possibility of abnormal levels in the presence of chronic inflammation:

  • 1,25(OH)2D has a short half-life (hours) and fluctuates rapidly.
    However, a high result may be discovered even at trough level.
  • 1,25(OH)2D levels are regulated by PTH, calcium, phosphate.
    This isn't true in chronic illness when extra-renal production is prevalent.
  • 1,25(OH)2D doesn't decrease until 25(OH)D is very low.
    Low 25(OH)D may be a sign that 1,25(OH)2D is abnormally high.
  • 1,25(OH)2D is only over-produced in hypercalcemic disease states such as sarcoidosis.
    Studies show this isn't true. [6]
  • 1,25(OH)2D may be elevated as a result of up-regulation of the CYP27B1 enzyme. This begs the question "Why is this enzyme elevated?"

Measuring both 25(OH)D and 1,25(OH)2D (also PTH, calcium, and phosphate when indicated) as clinical markers in chronic disease is more likely to provide a true picture of vitamin D status, than measuring 25(OH)D alone. [7] Consider assessing 1,25(OH)2D in patients with low 25(OH)D, abnormal lab results (especially inflammatory markers), a diagnosis of autoimmune disease or other chronic inflammatory illness, or signs of chronic systemic inflammation. For example, elevated 1,25(OH)2D is observed in Crohn's disease. [8] Each vitamin D metabolite test has specific parameters that must be followed to ensure accurate results.

D-metabolites Tests

 

 
Serum 25(OH)D

 

  • CPT code: 82306
  • Performed at most labs
  • No special handling needed
  • Lowest mortality reported at 20 ng/ml
  • Immunosuppression reported when higher than 30 ng/ml

 

Serum 1,25(OH)2D

  • CPT code: 82652
  • ICD-9 codes:
    • 275.40 Disorder of calcium metabolism, unspecified  
    • 733.00 Osteoporosis, unspecified
    • 733.90 Osteopenia
    • 780.9 Fatigue 
    • A specialized lab is required
    • Special handling of the sample is necessary- freeze for transport to avoid degradation due to agitation
    • A low result may be inaccurate due to sample mishandling
    • A high result is always accurate
    • Maximum normal = 45 pg/ml

In written correspondence (2013), vitamin D researcher Martin Hewison (Professor in Residence at the David Geffen School of Medicine UCLA), stated, "I agree that 1,25(OH)2D is a forgotten component of the vitamin D and human health story - I think measurement of serum 1,25(OH)2D will be more common as LC:MS techniques improve."

 

References

 

  1. Akbaraly TN, Hamer M, Ferrie JE, et al. Chronic inflammation as a determinant of future aging phenotypes. CMAJ. Sep 2013.
  2. Phillips CM, Perry IJ. Does Inflammation Determine Metabolic Health Status in Obese and Nonobese Adults? J Clin Endocrinol Metab. Oct 2013(98(10)):E1610-E1619.
  3. Strathmann FG, Laha TJ, Hoofnagle AN. Quantification of 1α,25 Dihydroxy Vitamin D by Immunoextraction and Liquid Chromatography-Tandem Mass Spectrometry. Clin Chem. Jul 2011;57(9):1279-1285.
  4. Antonoglou G, Knuuttila M, Niemel� O, et al. Serum 1,25(OH)D Level Increases After Elimination of Periodontal Inflammation in T1DM Subjects. J Clin Endocrinol Metab. Oct 2013(98(10):):3999-4005.
  5. Hollis B. Detection of vitamin D and its major metabolites. In: Feldman D, Pike JW, Glorieux F, eds. Vitamin D. San Diego: Elsevier Academic Press; 2005.
  6. Blaney GP, Albert PJ, Proal AD. Vitamin D metabolites as clinical markers in autoimmune and chronic disease. Ann N Y Acad Sci. Sep 209;1173:384-90.
  7. Perez T. Bacteria induced vitamin D receptor dysfunction in autoimmune disease; theoretical and practical implication for interpretation of serum vitamin D metabolite levels. Paper presented at: 6th International Congress on Autoimmunity, 2006; Porto, Portugal.
  8. Abreu MT, Kantorovich V, Vasiliauskas EA, et al. Measurement of vitamin D levels in inflammatory bowel disease patients reveals a subset of Crohn's disease patients with elevated 1,25-dihydroxyvitamin D and low bone mineral density. Gut. Aug 2004;53(8):1129-36.
About Chronic Illness Recovery

Diet Support Group

 

Recovery from chronic illness sometimes necessitates a reduction in body weight. If you are in this category, you may need guidance and support. CIR conducts an online dietary group for this purpose. Those who participate receive emails with information related to diets, exercise and weight management. The regular contact provides motivation to get started and incentive to persist if/when the going gets rough. If you would like to join, please send us an email [email protected]. 

 

Inflammation Therapy in the News 

Augusta, GA (WRDW) News 12 Special Assignment | Sarcoidosis: The struggle to survive

Contrast two stories of sarcoidosis.  

Leann has been using Inflammation Therapy and is back at work. The patient treated with conventional medicine is not so lucky.

 

Quotes 

I know that most men - not only those considered clever, but even those who are very clever and capable of understanding most difficult scientific, mathematical, or philosophic, problems - can seldom discern even the simplest and most obvious truth if it be such as obliges them to admit the falsity of conclusions they have formed, perhaps with much difficulty - conclusions of which they are proud, which they have taught to others, and on which they have built their lives. ~Tolstoy