GETTING TO THE HEART OF THE MATTER: IS VITAMIN D DEFICIENCY A MAJOR PLAYER IN CARDIOVASCULAR DISEASES, DIABETES AND HIGH CHOLESTEROL?

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A most interesting piece of research on the relationship of heart disease to blood levels of vitamin D was recently published in the American Journal of Cardiology.[1] Researchers from the Intermountain Heart Collaborative (IHC) Study Group studied 41,497 subjects with at least one vitamin D measurement from 2000-2009. The prevalence of vitamin D deficiency in the subjects was 63.6%. The researchers found that during that time period, those with the lowest levels of vitamin D had highly significantly increased risk of developing diabetes, hypertension (high blood pressure), hyperlipidemia (high cholesterol and triglycerides) and peripheral vascular disease, all diseases in their own right, and all risk factors for developing heart disease. They also found that those who had none of these risk factors, but who had severe D deficiency, had an increased risk of developing diabetes, hypertension and hyperlipidemia.

Low vitamin D levels were also correlated closely to coronary artery disease, myocardial infarction (heart attack), heart failure, stroke and overall risk of death (not surprising). Of particular interest was the fact that hypertension was nearly 90% more likely in those with low vitamin D levels (less than 15 ng/ml) compared to those who had high levels (greater than 30 ng/ml). Unfortunately, the analysis did not compare those who were severely deficient with those who had "optimal levels," which I would consider to be 60 ng/ml or more. Had they done that, it is likely that the differences in disease and death rates would have been even more impressive. Other findings of this study showed that infections, kidney failure and fractures were more likely among those with the lowest levels of vitamin D.

This research is one of the best conducted and controlled that I've seen, but it is hardly the only finding that showed a dramatic increase in these diseases when comparing people with low vitamin D levels to those with higher levels. One of the most impressive compared the risk of heart attack with vitamin D levels and found those with the lowest D levels to have 2.4 times the risk of heart attack compared to those with the higher levels.[2]

As you can see, vitamin D makes a difference. if you'd rather not have a heart attack, it behooves you to optimize your vitamin D levels!

There are another dozen research papers that point out a terrific difference in heart disease rates among people with different vitamin D blood levels; however, they all come to the same conclusion. Get some sunlight and optimize your vitamin D levels!


[1] Jeffrey L. Anderson, MD, Heidi T. May, PhD, MSPH Benjamin D. Horne, PhD, MPH
Tami L. Bair, BS Nathaniel L. Hall, MD,, John F. Carlquist, PhD, Donald L. Lappé, MD, and
Joseph B. Muhlestein, MD Relation of Vitamin D Deficiency to Cardiovascular Risk Factors,
Disease Status, and Incident Events in a General Healthcare Population. Am J Cardiol 2010;106:963–968)
[2] Giovannucci E, Liu Y, Hollis BW, Rimm EB. 25-Hydroxyvitamin D and risk of myocardial infarction in men. Arch Intern Med 2008;168:1174–1180.

Air pollution, sunlight, vitamin D and type-two diabetes

Does air pollution cause diabetes, or does pollution cause vitamin D deficiency, which then leads to diabetes?

New research from Germany showed that women who lived in heavily air-polluted areas were at greater risk for type-two diabetes than those who lived in less-polluted areas. Those who lived within 100 meters of busy roadways doubled the diabetes risk. http://www.newswise.com/articles/study-suggests-link-between-air-pollution-and-type-2-diabetes-in-women

The authors assumed that the inhalation of pollutants was responsible for the increased risk of diabetes among those living in heavily-polluted areas, but I suggest another possibility: It is well-known that air pollution filters out sunlight and correlates to profoundly lower vitamin D levels. [1] [2] [3]

But do vitamin D levels have an influence on type-two diabetes? Research shows that Vitamin D levels correlate closely to insulin sensitivity; the higher the vitamin D levels, the more receptive the body is to the action of insulin, which makes carbohydrates easier to metabolize.[4] This same study shows that the higher the vitamin D levels are, the lower are the blood sugar levels. Other research shows that men with the highest vitamin D levels had a 30% reduced risk of type-2 diabetes compared to those with low levels,[5] probably because the beta cells of the pancreas (the insulin producing cells) have vitamin D receptors[6] and function more efficiently when vitamin D levels are higher.[7]

It is highly likely that the reason for the increased risk for diabetes was not the inhalation of air pollutants, but rather the lack of sunlight and subsequent vitamin D deficiency. It is time to leave the pollution and return to the sun.



[1] Mims FM., 3rd Significant reduction of UVB caused by smoke from biomass burning in Brazil. Photochem Photobiol. 1996 Nov;64(5):814–816.
[2] Agarwal, K et al. The impact of atmospheric pollution on vitamin D status of infants and toddlers in Delhi, India. Arch Dis Child 2002;87:111-113
[3] Holick MF. Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr 1995;61:(Suppl):638S-645S.
[4] Chiu K. et al. Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr 2004;79:820-25.
[5] Mattila, C. Serum 25-hydroxyvitamin D concentration and subsequent risk of type-2 diabetes. Diabetes Care 2007;30:2569-70.
[6] Brown, A. et al. Vitamin D. American J of Physiol 1999;277(2 Pt 2):F157-75.
[7] Norman, A. et al. Vitamin D deficiency inhibits pancreatic secretion of insulin. Science 1980;209:823-25.

Vitamin D deficiency is costing Europe a fortune in lives and money!

Dr. William B Grant and his colleagues have just released a paper that analyzes the terrible financial burden that Europe is bearing due to lack of sunlight and vitamin D.[1] The diseases they mention that are related to vitamin D deficiency and have severe economic effects are “several types of cancer, cardiovascular disease, diabetes mellitus, several bacterial and viral infections, and autoimmune diseases such as multiple sclerosis.”

The reasons offered for the deficiency are high latitudes, indoor living (lack of sunlight exposure), lack of sufficient dietary vitamin D and lack of vitamin D fortification in most European countries. The cost is estimated at a staggering 187,000 million Euros per year.

These researchers estimate that the cost to educate and test the population and furnish the supplementation that would eliminate the deficiency—and thereby eliminate the diseases caused by it—would be about 10,000 million Euros yearly. What a great return on investment that would be! For every Euro spent on the program 18.7 would be saved.

Let’s hope that the heads of state listen to Dr Grant and his colleagues, and let’s pray that the U.S. and Canada do the same. We cannot allow vitamin D deficiency to take the lives of millions of people while we wait for more research to be sure. The research on the marvelous benefits of optimal vitamin D levels piles up weekly; the time to act is now.

Dr. Grant, by the way wrote the foreword for my book, and there is a tribute to his work therein. His dedication to informing the public and saving lives is second to none.

[1] Grant, W.B., et al., Estimated benefit of increased vitamin D status in reducing the economic burden of disease
in western Europe, Progress in Biophysics and Molecular Biology (2009), doi:10.1016/j.pbiomolbio.2009.02.003

Obesity in mothers leads to higher death rate in their children. Does vitamin D play a part?

On Friday, January 30, Yahoo News posted a Reuters article with the title, “Mom's obesity tied to higher infant mortality.”[1] This is not surprising. Obesity is closely correlated to many health problems, and one is the tendency of obese people, both children and adults, to be at higher risk for vitamin D deficiency.[2] [3] We have already discussed in previous posts that children born to vitamin D-deficient mothers have greater risks of diabetes, autism, weak bones and other maladies.

Although it is not known if it is vitamin D deficiency in the obese mother that causes a greater death rate in the children, the greater number of health problems among children of vitamin D-deficient mothers certainly makes the theory tenable. Expectant mothers who are obese would be well-advised to keep their vitamin D levels high for their benefit and the benefit of their developing babies.

[1] http://news.yahoo.com/s/nm/20090130/hl_nm/us_obesity_mortality;_ylt=Arm4zrlZzzAv3NBv7PMRLKrVJRIF
[2] Parikh, S. et al. The Relationship between Obesity and Serum 1,25-Dihydroxy Vitamin D Concentrations in Healthy Adults. J Clin Endocrinol Metab 2004;89(3):1196-99.
[3] Smotkin-Tangora, M. er al. Prevalence of vitamin D insufficiency in obese children and adolescents. J Pediatr Endocrinol Metab 2007;20:817-23.ttp://news.yahoo.com/s/nm/20090130/hl_nm/us_obesity_mortality;_ylt=Arm4zrlZzzAv3NBv7PMRLKrVJRIF

How much vitamin D do you need to reduce risk of cancer, osteoporosis, heart disease, gum disease, diabetes, hypertension, etc.?

My book cites research from over 800 medical/scientific journals research that consistently demonstrates a direct correlation between vitamin D deficiency and more than one hundred diseases and disorders. Only those whose heads are buried in the sand could believe that optimal levels of D are not necessary for excellent health. However, along with vitamin D’s newfound popularity, there is bewilderment about what is “optimal.”

What is the optimal level of vitamin D?

Dr. Bruce Hollis and his colleagues conducted research in which they determined that no circulating vitamin D3 can be measured in the blood until 25(OH)D levels are greater than 40-50 ng/ml.[1] This means that all vitamin D3 is used by the tissues to make 25(OH)D until the level is greater than 40-50. At that point, vitamin D3 begins to be measurable, meaning that the tissues are no longer so “hungry” for D3 that they use up every molecule made by the skin or taken orally. Therefore, optimal levels are probably somewhere over 50. Dr. John Cannell and I, in researching our book on vitamin D and athletics, found that athletic performance improves up to about 50-60 ng/ml and declines slightly at higher levels. In addition, a recent study showed that those with high vitamin D levels lived 26% longer than those with low levels; however, beyond 50 ng/ml, higher levels did not confer further advantage.[2]

How much vitamin D does it take to produce the optimal level of 50-60?

Each intake of 100 IU per day of supplementation raises the blood levels of vitamin D about 1 ng/ml. Therefore, if there were no sun exposure or a source of dietary vitamin D, it would require 5,000 IU of supplemental D3 per day to achieve a level of 50. This rule of thumb, of course, varies according to the size of the person; a large person will require more vitamin D than a small person. It is also interesting to note that men who have high levels of vitamin D (due to outdoor summer activity) must take 5,000 IU during winter to maintain those levels.[3]
A special case: nursing mothers

Nursing mothers must furnish sufficient vitamin D3 for themselves and their babies; if they are deficient, the babies have a greater risk of autism, schizophrenia and osteoporosis as they grow older. Dr. Hollis and his colleagues have demonstrated that nursing women need at least 6,400 IU per day to maintain adequate levels of 25(OH)D in both mother and child.[4]

Remember that in Caucasian skin, twenty minutes of full-body sunlight exposure (both sides) will produce from 10,000-20,000 IU of vitamin D. A good tanning bed will produce about 10,000 IU in ten minutes. In either case, be sure not to burn.

Hopefully, this information has reduced any confusion about optimal levels of vitamin D and how to maintain them. Get those levels up to 50-60 ng/ml!

[1] Hollis, B. et al. Circulating Vitamin D3 and 25-hydroxyvitamin D in Humans: An Important Tool to Define Adequate Nutritional Vitamin D Status. J Steroid Biochem Mol Biol. 2007 March; 103(3-5): 631–634.
[2] Melamed, M. et al. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med. 2008 Aug 11;168(15):1629-37.
[3] Heaney, R. et al. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 2003;77:204-10.
[4]Wagner C. et al. High-dose vitamin D3 supplementation in a cohort of breastfeeding mothers and their infants: a 6-month follow-up pilot study. Breastfeed Med. 2006;1:59-70.

Can vitamin D and sunlight exposure prevent type-two diabetes?

There are two types of diabetes: type-1 and type-2. Type-1 is generally known as “juvenile” diabetes, and type-2 is known as adult-onset diabetes. In type-2 diabetes (90% of all diabetes), insulin is sometimes necessary, but the real reason for the disease is the body’s inability to use its own insulin (insulin resistance).

Diabetes is increasing out-of-control as the population becomes increasingly obese and increasingly avoids the sunlight. During the 1990s, obesity increased by 61% and type-2 diabetes increased by 49%.[1] In 2007, the health-care and lost-productivity costs of diabetes were $174 billion, an increase of $42 billion over 2006.[2] Diabetes costs are now approaching those of cancer.

In an earlier post, I discussed the dramatically protective affect of vitamin D against the development of type-one diabetes (T1). Now we have a new study pointing to the fact that the epidemic of type-two diabetes (T2) is due in part to vitamin D deficiency. Researchers show that insulin sensitivity (necessary to prevent T2) is profoundly improved by vitamin D[3] supplementation. This is the second double-blind, interventional study (“gold-standard” research) to indicate that the risk of T2 is impressively reduced by supplementation. It confirms earlier observational studies, as discussed in my book.

An earlier study of adults with impaired sugar tolerance and insulin resistance (both risk factors for T2) came to even more impressive conclusions. For three years, half the group received a placebo and the others vitamin D plus calcium. The blood-sugar rise was fifteen-times higher in the placebo group, and the increase in insulin resistance was eighteen-times higher.[4]

The answer to T2 prevention: reduce junk-food consumption and achieve optimal levels of vitamin D (60 ng/ml). How? By non-burning sunlight exposure in summer and non-burning tanning bed exposure or supplements in the winter.

[1] Mokad, A. et al. The continuing epidemics of obesity and diabetes in the United States. JAMA 2001; 286:1195-1200.
[2] American Diabetes Association news release, January 2008
[3] Nagpal, J. et al. A double-blind, randomized, placebo-controlled trial of the short-term effect of vitamin D3 supplementation on insulin sensitivity in apparently healthy, middle-aged, centrally obese men. Diabet Med. 2009;261:19-27
[4] Pittas, A. et al. The effects of calcium and vitamin D supplementation on blood glucose and markers of inflammation in nondiabetic adults. Diabetes Care 2007;30:980-86.

Sunlight, vitamin D and African Americans, Part 2

In my previous post, I discussed reasons to believe that the generally poor health of African Americans is due in large part to vitamin deficiency. Here are more reasons to believe that the need for vitamin D is critical among this population.

1. Heart disease is twice as prevalent among black men as white men.[1] Although part of the discrepancy may be due to more smoking among black men, it is probable that a significant part is due to vitamin D deficiency. Low sun exposure and low vitamin D levels correlate to increased inflammation, higher cholesterol and hypertension, all risk factors for heart disease.

2. Heart failure is also much more common among blacks[2]—not surprising since we know the efficacy of vitamin D in preventing heart failure.

Now let’s discuss what is perhaps the most important study for African Americans. It is often argued that the excessive rates of cancer, diabetes, hypertension, etc. among African Americans are due to lack of access to health care. If that were the case, black physicians would have approximately the same lower rates of disease as their white counterparts, since black physicians obviously have high access to health care. However, research shows that even black physicians have a much higher incidence of cancer than their white counterparts.[3] But when black physicians have habits that provide higher vitamin D levels, they have approximately the same cancer rates as white physicians. Had the rates of heart disease, diabetes, hypertension and other diseases also been studied, along with measurements of serum vitamin D levels, I believe the pattern would have been even more clearly established.

Since African Americans have only 50-75% of the serum levels of vitamin D as whites,5 part—perhaps a large part—of the discrepancy between the health of the races could be rectified by nothing more than vitamin D supplementation of about 5,000 IU daily. That is very good news indeed!

[1] USA Department of Health and Human Services 1998. Tobacco Use Among USA Racial/Ethnic Minority Groups — African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: A Report of the Surgeon General. Atlanta: USA Department of Health and Human Services, Centers for Disease Control and Prevention.
[2] American Heart Association. Heart and stroke statistics – 2004 update.
[3] Giovannucci, E. et al. Cancer Incidence and Mortality and Vitamin D in Black and White Male Health Professionals: Cancer Epidemiol Biomarkers Prev 2006;15:2467–72.

Critical vitamin D deficiency and critically poor health among African Americans: Part 1

Why do African Americans suffer more from heart disease, cancer, hypertension, diabetes and other degenerative diseases than white Americans? One reason is that vitamin D deficiency is far more common in blacks.

In my book, I documented the relationship of vitamin D deficiency to dramatically increased risk of diabetes, cancer, heart disease, diabetes, hypertension and numerous other diseases and conditions--105 in all. If dark-skinned Americans are more likely to be deficient, it stands to reason that they would be more likely to succumb to those diseases.
Here are some interesting facts that relate vitamin D deficiency to poor health in black Americans:

1. When USA white and black women are compared for vitamin D levels, black women are ten times more likely to be vitamin D deficient.[1]

2. In patients in Minneapolis, Minnesota who were being treated for chronic pain, 100% of African Americans, along with Native Americans, East Africans and Hispanics were vitamin D deficient.[2]

3. Vitamin D is known to be a potent inhibitor of tuberculosis. African Americans have lower resistance to tuberculosis, lower levels of D and lower ability to produce cathelicidin, a natural internal bactericide.[3]

4. A 37-year-old disabled Black woman with myopathy (a muscle disease) and severe vitamin D deficiency was able to leave her wheelchair and function normally after six weeks of vitamin D therapy.[4]

5. Vitamin D deficiency leads to increased death from the major internal cancers, and a disproportionate number of those cancer deaths occur in African Americans.[5] Dr. William Grant, in summarizing the findings of his study on African Americans and cancer, wrote that “Solar UVB was found significantly inversely correlated with mortality rates for breast, colon, esophageal, gastric and rectal cancers for black Americans.” Other research in 2008 corroborated his findings, showing that in the Southeast USA, vitamin D deficiency is about four times more common in African Americans as whites, suggesting that the greater cancer risks among African Americans is due to that deficiency.[6]

Shortly I will post another blog citing research that further establishes vitamin D deficiency as a likely culprit in the poor health of dark-skinned Americans.

[1] Nesby-O’Dell, S. et al. Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third National Health and Nutrition Examination Survey, 1988-1994. Am J Clin Nutr 2002;76:187-92.
[2] Plotnikoff G. et al. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc. 2003;78:1463-70.
[3] Liu, P. et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science. 2006;311:1770-73.
[4] Prabhala, A. et al. Severe myopathy associated with vitamin D deficiency in western New York. Arch Intern Med 2000;160:1199-1203.
[5] Grant, W. Lower vitamin-D production from solar ultraviolet-B irradiance may explain some differences in cancer survival rates. JNMA 2006;98:364
[6] Egan, K. et al. Vitamin D insufficiency among African Americans in the southeastern United States: implications for cancer disparities (United States). Cancer Causes Control 2008;19:527-35.