January 20, 2016



 
Director's Letter 
Carole Baggerly 
Director, GrassrootsHealth 
 

Today we're presenting yet another set of vitamin D information from a different research point of view - enzymology. I had the pleasure this last week to talk with Dr. Reinhold Vieth, a member of our scientists panel, about bolus dosing with vitamin D. A specialty of his is the action of the enzymes. We recorded this interview, along with a few summary slides, to share his thoughts with you. I am frequently struck by how much is known about various pieces of vitamin D, and the depth of a researcher's knowledge. Dr. Vieth is one of those experts who has worked in many areas in the field and has extensive knowledge. His perspective on the recent study, done by very qualified scientists, which used large monthly doses and resulted in an increase in falls was "I would have predicted that they would have problems." Dr. Robert Heaney, our Research Director, likened the bolus dosing to thyroid medication. He said, "People on thyroid medicine generally take it daily. If they took it all in one dose, once a month, we would predict that they would be sick!"  I also spoke with Dr. Holick and he indicated that he gives 50,000 IU every 2 weeks to his patients and at that interval and dose, has not run into any problems.

So, my question: How do we get the messages of the science to practice not only in our daily lives, but also in the design of new trials? For example, giving bolus doses of 60,000 IU at monthly intervals is not effective, and has been shown to create problems. This was certainly expected by Drs. Vieth and Heaney. How can we make sure that no more trials are done at this level or at this interval? It is not a physiological dose. Just imagine getting enough sun exposure in ONE DAY to get that. Well, first of all, your body's system turns off the production of D from the skin after about 20,000 IU in a day's exposure. It knows better.

I hope you will listen to Dr. Vieth's interview and think again about dosing intervals and how they can make a big difference in our system's response.

We will continue to provide you some significant ways of looking at vitamin D research and what is found that is beyond the immediate news headlines. Please continue to spread the word about the fact that keeping a steady intake on a reasonably short time scale is important.  Dosing intervals matter.

Onwards!
 
Carole Baggerly 
Director, GrassrootsHealth 
A Public Health Promotion & Research Organization 
Moving Research into Practice NOW!
 
Monthly Dosing Creates a Paradoxical Vitamin D Deficiency

Reinhold Vieth, PhD
University of Toronto

Prof. Reinhold Vieth recently retired as director of the Bone and Mineral Group Laboratory at Mount Sinai Hospital, and remains active as a Professor at the University of Toronto in the Department of Laboratory Medicine and Pathobiology, as well as in the Department of Nutritional Sciences. He is an expert on the clinical nutrition, pharmacology and safety of vitamin D, and he has served as an expert adviser on vitamin D-related matters for the Institutes of Medicine, the Centers for Disease Control in Washington, the American Geriatric Society and Health Canada. He has been the principal investigator on many clinical trials involving vitamin D, ranging from osteoporosis, to multiple sclerosis and prostate cancer. Currently, his work relates to the utility of higher doses of vitamin D in health maintenance.

This audio interview with Vieth and Carole Baggerly is a discussion of the recent paper which used large doses of vitamin D - monthly. You will hear Vieth state that he was not surprised by the outcome, in part due to the research he conducted for his doctoral thesis on the enzymatic processes of vitamin D - how the body processes vitamin D (see paper below). He describes how big spikes in vitamin D create a false season and ultimately a paradoxical vitamin D deficiency. 
 
Vieth refers to large monthly dosing as "pulse dosing." Such doses spike the system and then are flushed out. Meanwhile the system is prepared for additional large amounts of vitamin D and when it doesn't get them enters a deficient state. Vieth concludes by postulating that if daily or weekly doses were given then there would have been no harm, and most likely would have seen a benefit.

Watch Video
Paper of the Week




How to Optimize Vitamin D Supplementation to Prevent Cancer, Based on Cellular Adaptation and Hydroxylase Enzymology
Published in Anticancer Research, 2009
Reinhold Vieth, PhD
University of Toronto
Mount Sinai Hospital, Toronto

Read paper

In this paper Vieth explains the biological and molecular processing of vitamin D in the body. He focuses on absorption and utilization in the pancreatic and prostate tissues because the paper was designed to explain why some cancer researchers found a correlation between high vitamin D levels and prostate and pancreatic cancer.

Take-away:
Keep your 25(OH)D concentrations high and stable all year long, not just seasonally. This will help prevent cancers - breast, colon, pancreatic and prostate.

Vieth goes into detail describing why it is bad to have a spike in 25(OH)D followed by a trough, explaining all the different forms vitamin D takes in our body. Here is a diagram that likens vitamin D processing to a water system. If you have a big flow of water, the spigots will open and spill into the next buckets faster. Then, what happens when drought comes? Vieth explains that the body is not quick to adapt (save water) between these rainfalls and droughts.

Click to Expand

Vieth's hypothesis is that this lag time in responding to rainfall/drought in both pancreatic and prostate tissue is what has shown negative results with vitamin D and those types of cancers.


N.B. The conclusion of this paper states that monthly dosing should work for trials. Here is Vieth's current position -

Back in 2009, my thinking was that vitamin D dosing intervals of up to a month were OK, but in light of Bischoff-Ferrari's latest findings in JAMA, I do need to step away from the one month interval. We now have two RCT's that indicate intervals of one month, or one year are too long. I personally have always stuck to a weekly intake schedule for vitamin D, and the same goes for any studies I have done.

IF higher 25(OH)D levels (30-80 ng/mL) were harmful then people living in tropical climes should suffer from more osteoporotic fractures and prostate cancer etc... I see no evidence for that and no plausible reason why. In the north, we have pulses of sunshine each summer that I contend are like pulse doses, and that seasonality is the culprit, not higher levels per se.

 
Editor's Letter 
Susan Siljander 
Marketing Director, GrassrootsHealth


I first heard about the importance of daily dosing from Dr. Bruce Hollis when I summarized his talk and paper on this subject. It makes a lot of sense. You wouldn't lump all your exercise for the month into one day (although my husband is an ultra-marathoner and has been known to do that). For the same reason you don't want to lump all your vitamin D up into one day every month.
Drs. Hollis and Vieth explain it scientifically - so if you need another reason to be convinced - here you go! For your health try and get vitamin D daily - from food, sun, and/or supplements. The more constant you can keep your vitamin D level the better equipped your body is to fight disease.

I am very excited about launching our new web page - Looking at Research with a Careful Eye. I often see so many conflicting research summaries out on the Internet - so we hope this page will be one you can go to when a controversial study comes up. We also have older controversies up there (like the current RDA being too low!).


Thank you,

Susan Siljander
Marketing Director, GrassrootsHealth
A Public Health Promotion & Research Organization  
Moving Research into Practice NOW!
 
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Dr. Reinhold Vieth discusses the findings from a recent paper which used large doses of vitamin D - monthly. Vieth describes how big spikes in vitamin D create a false season and ultimately a paradoxical vitamin D deficiency.




Paper of the Week 

How to Optimize Vitamin D Supplementation to Prevent Cancer, Based on Cellular Adaptation and Hydroxylase Enzymology
Published in Anticancer Research, 2009
Reinhold Vieth, PhD
University of Toronto
Mount Sinai Hospital, Toronto




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