Saturday, June 26, 2010

Vitamin D for rheumatic diseases: how much is “sufficient?”

Two June research reports show that most patients with rheumatic diseases have levels below the “normal” range of vitamin D, considered in the report to be 48-145 nmol/L. In US measurements, that number is equivalent to 19.2-58 ng/ml. The diseases assessed within the reports were inflammatory joint disease, osteoarthritis, rheumatoid arthritis, myalgia, and osteoporosis.

The research also showed that supplementation of 800-1,000 international units (IU) was not sufficient to normalize vitamin D levels in most patients.

A problem with such studies is that researchers must be in the dark ages not to know that 32 ng/ml is considered the lowest healthful level of vitamin D, and that optimal levels are 50-60. Therefore, when people are below the level of 19, they are not only below deficient, they are severely deficient. In these studies, it is likely that 80% of the people would have been deficient if the appropriate measure of 32 ng/ml had been used, and it is also likely that 100% were suboptimal.

An important fact is this: one minute of full-body sunlight exposure around noon can produce as much as 1,000 IU of vitamin D. This is Nature’s way. It is counterintuitive to suppose that a supplement of only 1,000 IU would be sufficient to achieve optimal levels of vitamin D, if Nature produces vastly more with within 20 minutes. And, in those seasons when vitamin D is not available, many vitamin D scientists now recommend 3,000-5,000 IU daily. Using the miniscule quantities of 400 IU (multivitamin tablet) to 1,000 IU to eliminate the inflammation of diseases like rheumatoid arthritis, unexplained muscle pain and chronic back pain is like trying to attack an elephant with a bb gun.

In all cases in these research papers, the subjects who had the lowest vitamin D levels also had the greatest disease activity, which is not surprising; vitamin D is powerful antiinflammatory hormone, and without it we suffer. More research need to be conducted, using 3,000-5,000 IU daily, or getting people outside with a lot of skin exposure when the sun is direct (without burning of course).

About one year ago I posted a blog that explained a great deal about rheumatoid arthritis and the influence of vitamin D in preventing and reducing the risk of the disease. The following is a repost of that blog, which fits in nicely with what we have just discussed:

Do you suffer from rheumatoid arthritis (RA)? Can vitamin D help?

Both dietary and supplemental vitamin D reduce the risk of RA, which is an autoimmune disease—a disease in which the body’s immune system attacks its own tissue. In a study of 29,000 women, those who ranked in the top third of vitamin D consumption had one-third less risk of RA.[1] It is likely that a greater vitamin D intake would have produced much better results, since it is virtually impossible to ingest sufficient vitamin D from food and multivitamins.

In studies performed on mice, vitamin D was shown to inhibit the progression of rheumatoid arthritis and minimize or prevent symptoms.[2] The same is true in humans. In subjects diagnosed with a form of the disease known as inflammatory arthritis, the lower the vitamin D levels are, the higher is the disease activity.[3] Vitamin D's anti-inflammatory properties and its ability to reduce the autoimmune response are likely responsible for the improvement in RA.[4]

Investigations also find that RA is more common in winter, consistent with the idea that vitamin D is a major factor in reducing the risk.[5] In a report from researchers in Ireland, it was shown that 70% of patients had low vitamin D levels and that 26% were severely deficient.[6] However, in that report, 21 ng/ml was considered as the deficiency level and 10 as the severe deficiency level. A level of 21 is dangerously deficient. The ideal level of vitamin D is 50-60 ng/ml. Using those numbers, it is likely that all of these patients ranged between deficient and severely deficient.

In our health institute/resort, we observed that guests with arthritis often regained full range of motion in their joints from a week to a month after beginning a program. I assumed that our anti-inflammatory vegetarian nutrition was responsible for the positive results. Now I realize that many of the benefits came from sunlight exposure during outdoor exercise.

RA prevention and relief are two more reasons to obtain regular, non-burning sunlight exposure. Remember that sunscreens can prevent 99% of vitamin D production by the skin.

[1] Merlino, L. et al. Vitamin D intake is inversely associated with rheumatoid arthritis: Results from the Iowa Women’s Health Study. Arthritis & Rheumatism 2004;50:72-77.
[2] Cantorna, M. et al. 1,25-Dihydroxycholecalciferol inhibits the progression of arthritis in murine models of human arthritis. J Nutr1998;128:68-72.
[3] Patel, S. et al. Serum vitamin D metabolite levels may be inversely associated with current disease activity in patients with early inflammatory polyarthritis. Arthritis Rheum 2007;56;2143-49.
[4] Cutolo, M. et al. Vitamin D in rheumatoid arthritis. Autoimmune Rev 2007;7:59-64.
[5] Cutolo, M. et al. Circannual vitamin D serum levels and disease activity in rheumatoid arthritis: Northern versus Southern Europe. Clin Exp Rheumatol 2006;24:702-4.
[6] Haroon, M. Report to European Union League Against Rheumatism , June 13, 2008.

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