Ask Dr. Vitamin
Posted on September 22nd, 2008 – 7:00 AMBy Josephine Marcotty
Today on BodyTalk Dr. Greg Plotnikoff will answer your questions about vitamin D — how to get enough and what happens when you don’t.
Plotnikoff, medical director of the Institute for Health and Healing at Abbott Northwestern Hospital, may know a lot about health care, but he’s obsessed with vitamin D. It’s far more than your run of the mill nutrient. It regulates hundreds of genes, and not getting enough of it has been linked to more than dozen different kinds of cancers and many other diseases.
Those of us who live up here on the tundra are especially vulnerable, because it’s just not possible to get enough vitamin D from the sun in the winter. Even in summer, slathering sun screen on you and your loved ones blocks UVB rays — and vitamin D.
But how much is enough? How do you balance too much sun with not enough? What’s a redhead to do? We all need supplements, especially in winter, but how many pills should you take? And infants?
Ask Dr. Vitamin. You can post question anytime, and he’ll share his wisdom here this afternoon starting around 1 p.m.
102 Responses to "Ask Dr. Vitamin"
My brother had cancer of the pancreas lived 18 months and now a first cousin is now dignose with it. Can Vitamin D help him? He can not have surgery he has lost 30 pounds and is doctoring at the Mayo clinic.
Also my mother has Fibromyelgia she is 81 years old and suffers with pain when it flares up, some of the things that brings on the attachs are the weather changes rain or snow also when she is under stress. Can Vitamin D help her if so how much should she take.
I started taking Vitamin D supplements a couple of months ago. Is there any specific type of Vitamin D supplement that you would recommend? Also, what about dosage? Some articles I have read have recommended 1000 IU daily and others have recommended 2000 IU daily. Which is the best dosage to take for optimal effect? If it matters, I am a male in my mid-40s, 6′2″, 225 lbs.
Hello,
A friend of mine in his late 20’s is from a part of the world that has a considerably more “steady” climate that includes more sun and opportunity to be outdoors than here (he was born near the equator in Asia). Lately, or since he has lived here (over 5 years), his overall health has declined and depression seems to be a problem for him. When he goes back to his country for a few weeks he always returns looking rejuvenated and more healthy and seems to have lost weight. I have brought up sunlight, sun lamps, vitamin D etc. with him, but he’s not interested or says he doesn;t have time.
How long would taking D take for him to notice a difference? How can I prove to him that his D levels may be low (if they are)?
Thanks,
Diane
I was found to be terribly deficient earlier this year (<10 ng/mL) when tested for Vitamin D. I’ve been more aware about how much sun exposure I get as well as taking 2,000 I.U. a day. I’ve brought my blood levels up quite a bit but I am still below normal range. I have noticed some improvement in my overall well-being since I’ve been getting more D in my diet, e.g. less bone pain, more muscle strength, more alert, and so on.
My question is can taking high doses of oral Vit D cause or worsen stomach discomfort and/or heartburn? Would I notice a difference between gel caps or tablets? My stomach discomfort usually happens within 20 minutes of taking the supplement and then continues for the rest of the day. I’ve tried taking Vit D after meals or with lots of liquids and neither seems to help or make it worse. Your input is appreciated.
My daughter has severe allergies, asthma which still at the young adult stage is difficult to control, soft teeth and cavity problems despite very attentive brushing and use of mouth wash and depression issues which is also difficult to control.
She does not drink milk (it makes her ill), works indoors and spends minimal time outdoors.
Do you have any thoughts or suggestions?
Thanks.
The common recommendation has been 15 minutes of daily sun exposure to get your daily dose of Vitamin D. Obviously, this depends on your skin color, age, etc. How much time do you need to be in the sun to get enough Vitamin D during April - Sept., and again during October - March in Minnesota?
Is there any type of credible certification for vitamins and supplements like lutein? I’ve heard that some products don’t contain what they say and would like some assurance before I buy.
Wondering if there is any risk of Over dosing on Vitamin D ? I take a small amount every day . I don’t go out of my way to get extra sun exposure .The risks of skin cancer make taking a small supplement the way to go ?
How do you recommend giving vitamin D to children.. Dosage? What is the relationship between ADHD and vitamin D. My children are at ages they will not swallow a pill. (Oldest is 7, youngest 2)
I was diagnosed with crohns earlier this summer and after spending a miserable weekend in bed with sypmtons - what dosage of vitamin d can i add to my diet and what are the desired effects it will have on my intestines /system ???
Our pediatrician suggested that we give our newborn a D supplement. I am currently giving him an infant A/C/D formula and I’m wondering if this is the best supplement, or should I consider cod liver oil or some other source. (I am breastfeeding and take a prenatal, calcium, cod liver oil and 400 iu of D in the winter)
thanks.
Good morning everyone–
Thank you for your questions. I will respond throughout the day today.
Please be aware that I cannot provide specific medical advice for a specific patient…I believe that we all agree that doctors should not practice medicine without actually seeing, interviewing and examing the person with health concerns.
I will answer everyone’s questions with factual data and information on resources.
Please also allow me to share my bias:
1) we should focus first on fundamentals, then on pharmaceuticals
2) true primary care is what we do for ourselves
3) much of true primary care is actually free.
I look forward to your questions and concerns. Please keep me busy!
I wish you well,
Gregory A. Plotnikoff, MD, MTS , FACP
Medical Director,
Institute for Health and Healing
Abbott Northwestern Hospital
Minneapolis, Minnesota
Ms. Sanders–
Thank you for your question on Pancreatic Cancer. I wish your cousin well. Here is what pancreatic cancer doctors need to know:
Vitamin D deficiency appears to be a risk factor for pancreatic cancer development and progression.
Pancreatic cancer incidence and prevalence correlates strongly with latitude and sun exposure.
Per the Nurses Health Study, the Physicians Health Study and the Health Professionals Follow-up Study, vitamin D intake is associated with significantly decreased risk of pancreatic cancer in both men and women.
Pancreatic islet and duct cells express the 25-OH-alpha hydroxylase enzyme that activates vitamin D.
Activated vitamin D is a secosteroid that regulates gene expression for control of cellular proliferation, differentiation and apoptosis.
Pancreatic cancer cells express the vitamin D receptor.
Vitamin D and its analogues reduce pancreatic cancer cells in vitro and in vivo.
Blood test: 25Hydroxy vitamin D
Goal: serum levels greater than 40 ng/ml (100 nmol/l)
Significant Deficiency: <21 ng/ml (50 nmol/l)
Should your cousin’s doctor have any questions or concerns, please have her or him contact me.
Thank you.
GP
Fibromyalgia–
Fibromyalgia is not fibromyalgia until vitamin D levels have been tested and proven to be normal.
In fact, for all people with long-lasting, non-specific pain in muscles, bones and joints, their vitamin D level should be tested. (25-hydroxyvitamin D is the name of this test). A shockingly large number of people have very low levels of vitamin D. And, as so many physicians in Minnesota, the US and around the world have affirmed in emails to me, simply treating with vitamin D resolves these aches and pains. The goal is to achieve serum levels greater than 32 ng/ml with a PTH level of 50 or less.
For years I have tried to go outdoors at noon in the winter for even 5 minutes; it keeps my mood up. For vitamin D intake in the winter, do you have to have significant amounts of skin exposed?
My daughter moved to Fairbanks Alaska last year and is suffering with significant pain in her muscles and joints (worse than when she lived here in MN and even that was a problem.) They of course have significantly less light/sun than we do in winter. Any suggestions for her? Should she ask to have her vitamin D levels checked? How does she avoid the stomach upset that comes with taking Vitamin D? Her stomach is often upset anyway.
Vitamin D supplements: How much? What kind?
Vitamin D comes in two forms:
D2, ergocalciferol, from sun exposed mushrooms
D3, cholecalciferol, from lanolin in sheep wool
I recommend D3 supplements of at least 1,000 international units per day for all Minnesotans of all ages.
This is true for both short children and for tall adults.
Please note:
The more we weigh, the more D we need.
This applies to people who are heavy or obese.
The darker our skin in Minnesota, the more we need.
The more we cover our skin, work indoors or wear sun screen, the more we need.
If we use prednisone or certain seizure medicines or certain other prescription medications such as warfarin, rifabutin or rifampin, then we should be tested and supplemented.
And, for people at risk or with symptoms, I recommend getting a blood test for 25hydroxyvitamin D.
Why? Some people require much, much higher doses to achieve a good level.
What is a good level? At least 32ng/ml (80 nmol/l).
Yes, having two measuring systems is complicated. Please note that 32 nmol/l is very deficient! And, 80 ng/ml is on the high side…persons with such levels tend to be farmers and lifeguards in sunny climates. Minnesota office workers tend to have levels around 25 ng/ml (deficient).
GP
What is Institute for Health and Healing? I have not heard of this before? I always here doctors asking if I take supplements or excersice but I never get feedback from them on what to do? Why is that?
Vitamin D and mood–
Diane–thank you for this question.
Let me start with an important note for all readers.
Mood disorders are serious and persons affected need to partner with a health professional.
Please remember this: self-diagnosis and self-treatment may place one at risk of self-malpractice.
Please note that persons with mood disorders may have many other potential causes than vitamin D deficiency. This can range from omega-3 fatty acid deficiency or B vitamin deficiencies, to homesickness to work/life stress to a large number of medical diagnoses.
That being said, I can add this:
People from sunny countries in SE Asia, Indian subcontinent, equatorial Africa, the mediterranean and the middle East require significantly more sun exposure than can be obtained in Minnesota.
We can only make vitamin D between April and September. Even a stark naked person outdoors on a sunny day in winter, at noon, cannot make a drop of vitamin D in Minnesota.
This is a problem.
This is a big problem for people with dark skin.
There are vitamin D receptors throughout the brain on both the thinking parts and the emotion/mood parts.
I have found that some people experience very quick responses (one week) and some people require as long as 6 months of high dose prescription treatment. The goal is to achieve a serum level of greater than 32 ng/ml with a normal PTH. (partner with your doctor on this)
I cannot answer specifically for your friend but I can share this story which may parallel the experience of many people in Minnesota.
Recently, the British Medical Journal presented a case of a woman living in London who was originally from Pakistan. She was thought to have metastatic breast cancer in her bones. She went back home to Pakistan and returned 6 months later with no signs of any disease. (without treatment) Then, after a few years, everything returned. She went back home and, again, 6 months later returned with everything cleared. After living in London again, her symptoms returned. This time her physicians measured her vitamin D and found her to be very low in vitamin D. Treatment with vitamin D rather than chemotherapy cleared her signs and symptoms.
My sense is that two significant risks/differences exist in Minnesota:
1) absence of vitamin D producing rays from late September to mid-April
2) absence of signficantly important nutritional content of much food served here.
I wish your friend well.
GP
Vitamin D and stomach discomfort–
CM–So glad to hear that your vitamin D level was checked. And, everyone, CM’s story of significantly improved symptoms is what I hear so frequently.
These stories are what drive me to promote vitamin D awareness.
Some people require very high doses to achieve adequate blood levels (greater than 32 ng/ml). I know of one young (45), thin, outdoorsy person who was on 2,000 IU per day for two years…and her level when rechecked was only 19 ng/ml!
This is why checking levels is so important: it guides rational dosing.
OK, stomach concerns:
In my experience, taking vitamin D on an empty stomach can cause nausea. Taking vitamin D with some fat containing food (like whole milk yogurt)
should free you from any stomach concerns.
Take care,
GP
Who should be tested? Asthma? Allergies?
Cavities? Depression?
CRS–Thank you for writing. The symptoms you describe of allergies, asthma, cavities and depression can be due to many medical causes.
Low vitamin D has been correlated with both allergies and asthma.
Vitamin D regulates TH1 and TH2 balance, the parts of the immune system which can be out of balance with allergies and asthma.
Recently, Dr. Banerjee and colleagues at the University of Pennsylvania Medical School demonstrated that vitamin D postively affects airway smooth muscles, the very muscles that tighten up and squeeze our airways in asthma. The important point is that vitamin D does this by positively changing the inflammation in airways in a way different from the work of inhaled steroids.
So, anyone with asthma, particularly those on prednisone, should make sure that they have normal levels of vitamin D.
For dental health, many articles have shown that gingivitis is strongly associated with low vitamin D levels.
I know that from my days working in the Phillips neighborhood (1993-2002), many, many children suffered from both severe cavities and lead poisoning.
Now we know that both are linked to low vitamin D levels. Leaders in pediatric health at the University of Minnesota, including Amos Deinard, MD, a true hero for all children in Minnesota, are looking into this.
For mental health, please see my comments on vitamin D and mood.
The blood test for vitamin D is simple: 25-hydroxy vitamin D. The goal: levels greater than 32 ng/ml.
Take care,
GP
Hi Greg and Josephine:
Does using one of those indoor artificial lamps that are sometimes recommended for people with Seasonal Affective Disorder also help with Vitamin D deficiency in the winter?
Thanks and keep up the good work.
My child has Epilepsy and recently t he neuro told us that with the anti-epileptic drugs out there that they are showing that people on them should be taking more Vit. D. Do you have any info on this and is it ALL anti-epileptic drugs?
Thank you!
How much sun do we need?
Thank you AJ for this question.
We can only make vitamin D when in the sun mid-late April to mid-late September. We Gophers/Badgers are too far north from the equator.
Here are general rules:
1) safe sunning: no burns please!
2) 15 minutes a day from April to September is enough for a thin, white, young person who does not smoke or take certain prescription medications.
3) the more color in our skin, the more sun we need. Persons with ancestors from Asia (including India and Pakistan), Africa, the Middle East and South America require more sun than persons with ancestors from Scandinavia and northern Europe.
4) the bigger we are weight wise, the more we need. Obese people are at higher risk for low vitamin D.
5) the older we are, the more sun we need. Skin efficiency for vitamin D at age 70 is just 1/3 that at age 20.
6) the more sunscreen we use, the less likely we are to make vitamin D. SPF-8 reduces vitamin D production by 95%.
7) we cannot make vitamin D behind glass and under clothing.
the best sun for making vitamin D is between 10 and 3, the very hours we are at risk of burning.
9) we cannot overdose on vitamin D from the sun: the body stops producing vitamin D after a certain point.
10) there is only so much vitamin D one can make on a given day. Ten hours of sun is not better than one hour of sun.
Cheers,
GP
Safe vitamins?
John–yes, there are certifying bodies for vitamins and other supplements.
The best known is Consumerlab.com
http://www.consumerlab.com/
This was started by some former FDA scientists.
The Council for Responsible Nutrition (CRN)has been very active in this field.
http://www.crnusa.org/
For vitamin D, please note that the labels on milk bottles may not equal the contents. A study in the 1990’s found 28% of all skim milk samples contained no vitamin D at all.
GP
Overdose on D? Skin cancer?
Gary–
Yes, too much vitamin D is toxic.
The dose determines the poison.
One needs to be taking 10,000 IUs per day for a long time to achieve dangerous levels. (greater than 150 ng/ml)
I do not recommend that people take more than 2,000 international units a day unless they have had their vitamin D blood test.
The best dosing is guided by the numbers.
Vitamin D from the sun is free. Low levels of vitamin D appear to increase the risk of skin cancer.
What? Did our maker give us the capability to live and work outdoors?
This appears to be true. More and more studies are appearing which link low vitamin D to the skin cancers that we worry most about.
For those people who are unable to access the sun, then supplementation is the way to go.
Milk, fish, cereal have small amounts of vitamin D. A bowl of fortified cereal with fortified milk gives at best just 15% of the 1,000 IUs Minnesotans need every day.
Multivitamins contain only 400 international units, not the 1,000 we need.
Pre-natal vitamins often contain only 200 international units…which makes them completely insufficient to reduce risk to the infants.
Calcium tablets that contain vitamin D often contain only 200 international units or even less.
The scientific evidence suggests that all Minnesotans should practice safe sunning (no burns please!) and supplement with vitamin D 1000 international units a day.
GP
I have Crohn’s Disease, and due to things I’ve researched and read on here from some of your responses (gingivitis) and other skin conditions, I strongly believe I’m deficient in Vit D. I’ve tried taking oral supplements of Vit D with little results. It seems the one and only way I’ve experienced success is Vit D directly from the sun. This being the case, is there another form of Vit D I might try, such as liquid or would the benefits of indoor tanning outweigh the potential risks in this case? Thanks.
Hello Dr Greg,
I am taking Vit D (1200) per day and I believe it does wonders for mood, etc. I have been diagnosed (almost 4 yrs) with MS, but take no meds for it. The improvement has been ongoing, since beginning a diet of no wheat, diary or gluten (2 1/2yrs) Would you suggest more — or should I have levels checked? Also, does it play a role in the thyroid? My synthroid dose was just reduced after the same level for 5 years.
PS — I believe that we went to school in Lake Bluff together?
vitamin D and kids–
There are liquid forms of vitamin D which are kid friendly.
As for ADHD, Drs. McCann and Ames at Oakland Childrens Hospital in California, documented this year that there is ample biological evidence to suggest an important role for vitamin D in brain development and function.
Given that the University of Pittsburgh documented this year that 55% of mothers (and their babies) at the time of delivery were significantly vitamin D deficient, despite being on prenatal vitamins, there is strong reason to support vitamin D supplementation in infants and children.
I should note that breast fed children are at higher risk of deficiency than bottle fed children. However, this may be because the mothers may be so deficient. I do recommend supplementing mothers and children when breast feeding. Higher than usual supplementation may be important for mothers: this should be guided by measuring the vitamin D level in a blood test.
I wish you and your children well,
GP
I have been diagnosed with severe osteoporosis. This was about 5 years ago. Since then I have been taking actenol every week, and bone scans have not changed. I want to stop taking actenol, and try to work on diet instead. How much vitamin D should I take alont wiht calcium?
Crohns and vitamin D–
Dear Nancy–
Yes, there is a strong connection between Crohns and low vitamin D.
This is worsened for people on prednisone.
For all persons with inflammatory bowel disease, I recommend obtaining a blood test for vitamin D (25-hydroxyvitamin D).
This is important for several reasons.
1) low vitamin D is associated with immune imbalance found in auto-immune diseases such as Crohn’s.
2) persons with Crohn’s disease are almost always vitamin D deficient.
3) vitamin D, as a fat-soluble vitamin, may not be well absorbed with certain bowel diseases
4) persons with inflammatory bowel disease are often on prednisone (a great drug but unfortunately an anti-vitamin D agent) or on anti-TNF drugs which place them at higher risk for infectious diseases such as TB.
(TB risk increases as vitamin D levels go down)
5) persons with inflammatory bowel disease are at risk of colon cancer. There is sufficiently strong evidence connecting low vitamin D with risk of colon cancer.
Our colleagues in gastroenterology are increasingly paying attention to this fundamental issue.
I wish you well,
GP
I have been diagnosed with severe osteoporosis. This was about 5 years ago. Since then I have been taking actenol every week, and bone scans have not changed. I want to stop taking actenol, and try to work on diet instead. How much vitamin D should I take along with calcium?
Scientific Evidence is Strong: Public Awareness is Weak
Vitamin D is much more than a vitamin: when vitamin D is activated, it becomes a potent seco-steroid, similarly powerful to the better known testosterone, estrogen or thyroid hormones.
Activated vitamin D binds to receptors throughout the body and regulates over a 1000 genes. These genes regulate blood pressure, glucose metabolism, immune function, cellular growth, differentiation and programmed cell death.
The leading medical journals of the world have addressed this issue in editorials, articles, etc. For reference, here below, in serial order, are some very readable and authoritative statements which support what was stated in the Star Tribune article. Note that these calls for more attention have existed for at least 10 years.
1. Eugster EA, Sane KS, Brown DM. Minnesota Rickets. Need for a
policy change to support vitamin D supplementation. Minnesota Medicine.
1996;79(8):29-32.
2. Compston JE. Vitamin D deficiency: time for action. British Medical Journal.
1998;317(7171):1466-7.
3. Utiger RD. The need for more vitamin D. New England Journal of Medicine.
1998;338(12):828-9.
4. Stokstad E. The vitamin D deficit. Science. 2003;302:1886-8.
5. Zitterman A. Vitamin D in preventive medicine: are we ignoring the evidence? British Journal of Nutrition 2003; 89(5): 552-72.
6. Meier C. Scientists probe role of vitamin D: deficiency a significant
problem, experts say. JAMA. 2004;292(12):1416-8.
7. Holick M. Vitamin D deficiency. New England Journal of Medicine 2007; 357: 266-81.
8. Holick M. Deficiency of sunlight and vitamin D. British Medical Journal. 2008;336:1318-9.
I have heard that vitamin d does not get absorbed when it is taken with other vitamins, as in a multivitamin supplement. That it has to be taken alone. Is this true?
Dear Dr.:
What about tanning beds? Can they provide part of the solution to low Vitamin D levels? Do they have the same type of light as the sun?
Thank you.
Dr Plotnikoff -
Two questions -
1 - I have been on a proton pump inhibitor for 8 years for GERD. I have suffered through numerous unsuccessful attempts to wean off of them. I also have IBS that I have been managing fairly well by monitoring my diet. Is there a connection between the proton pump inhibitors and the body’s ability to absorb appropriate nutrients such as Vit D?
2 - I work in public health with many Somali families. We, too, are experiencing families refusing vaccinations due to myths/fear of autism. Obviously, we are concerned about the outbreaks of measles in our community because people are receiving poor information regarding vaccine. Sweden is currently studying this vitamin D deficiency and Somali families demonstrating an increase in autistic symptoms. Do you know about work in Minnesota to assist Somali families regarding Vitamin D deficiency - education and/or treatment?
I appreciate your time for everyone writing in today.
I often see Vitamin D supplements combined with Vitamin A. What is the rationale for this, are these two vitamins symbiotic? Also, are there vitamins or minerals that compete with vitamin D for absorption?
Thanks!
To follow-up, since you say Vit D may not be well absorbed for people with IBD, what form do you suggest getting it in then?
Thanks!
I have osteoarthritis, that dictates my daily activities.I have had a joint replacement,and stenois in my cervical and lumbar spine.
My question is can vitamin D encourage soft tissue regrowth between my joints?
I don’t understand why more emphasis is not being put on getting Vitamin D the natural way.
For years, tanning beds have been manufactured to mimic the sun and it seems obvious to me that if a person goes tanning in Minnesota in the winter time a couple of times a week and does it in a way where they are not sunburning, doesn’t this give them the Vitamin D they need, instead of pumping their body full of supplements?
I have two sons on the autism spectrum (high functioning), also with asthma, AHDA, and tons of allergies. We have tried all sorts of traditional and non-traditional medicinal approaches. They both have extensive yeast problems. Any thoughts?
Have vitamin D supplements helped with rheumatoid arthritis
Hi ~
I am slightly hyperthyroid and have a goiter that has been growing slowly over the past few years. I have had a couple biopsies done to make sure it is not cancerous which it is not. Being that this is an autoimmune disease, can Vitamin D cure this? I have been taking a natural approach to my condition and am not taking medication and am also trying avoid having the goiter removed to avoid the possibility of having to go on thyroid medication. Thank you for your comments/insight in advance.
Steve
Just recently in the Minneapolis paper there was an article on so many Somali children having ADHD.Do you think both the parents and the children could be very Vitamin D deficient?
My daughter is 21 years old and unfortunetly a frequent flyer of United hospital.
She has epilepsy, is on 3 meds for seizures and a whole host of other meds for other conditions.
She is also on the Ketogenetic diet.
She is fair skined and gets nowhere near the sun exposure she needs.
She also does not walk, but does use a stander for 45 min per day.
In general, with someone like her, what would you say would be an apropriate dose of Vit D?
Seizure meds are at max doses: Phenobarb, lyrica, & Topamax.
Thank you,
SC
My Vitamin D (25-hydroxy) level is currently 21.9. The dr. wants me to take 50,000 units of vitamin D once a week for 3 months, which he says is standard treatment. I am a slim 53-year-old Caucasian female with osteopenia, low thyroid (take Synthroid), chemical sensitivities and arthritis and take St. John’s Wort for depression. That seems like too much Vit. D. Last time my level was low, I got more sun and took 2,400 units a day and got it in the normal range. Comments in general on taking that much Vit D at one time? (Bye. I’m off to do some safe sunning.)I did not realize until I saw Sunday’s article that St. John’s Wort could be causing me to need more Vitamin D. Sigh. I love St. John’s Wort.
Julie
I was very interested in your recent article. My 24year old daughter has been suffering with chronic daily headaches for 10 YEARS! We have done CT scans, various meds, acupuncture, biofeedback, magnesium supplements with no success and no answers. Could Vitamin D help in this case. Your article mentioned one woman with “squishy headaches” whatever that is.
Can Vitamin D help with moderate to severe psoriasis? My fiance suffers terribly from this and takes weekly injections of Enbrel to help. I have been taking Vitamin D along with eating a completely gluten free diet for over a year now and have found great relief from constant pain.
I’m five years post-op from gastric bypass surgery. My vitamin D level is at 21. I was taking about 800 mg of vitamin D per day and have increased it to about 11,000 per day. I’ve heard about vitamin D injections that are available overseas but not here in the US. Can you comment on that? Injections would be better absorbed with my plumbing I would think - I’m already taking a hand full of vitamins! Thanks for information!
I have been amenemic for 5 months and per my family physician’s instructions, have incresed my iron (from Ferranyl) to 180 mg withnot a lot of improvement. I have inactive Crohn’s (never had surgery) and had Roux en Y gastric bypass 3 years ago. I find that many doctors are not aware that this has longterm impacts on absorption (for e.g., they keep prescribing me time-release meds). Anyway, I am wondering if I could be Vitamin D deficient. Could that be the cause of persistent anemia? I don’t think my fam Dr. has checked vit. D. I do take a multi-vit and B12 specifically formulated for post-bariatric. Would there be any harm to just start vit D therapy on my own?
Oops, I am anemic, although “amenemic” sounds much more exotic!
If a multivitamin says 400 IU is that
getting absorbed into your body or do
you need to take it separate? Also my
husband has rheumatoid arthritis could
Vitamin D help? If so how much?
Supplements for children? Cod Liver Oil?
Dear Ms. Anderson–
Yes, children in Minnesota need vitamin D year round…especially if they are breast feeding.
This is usually easy with liquid forms of vitamin D.
For breast feeding mothers to obtain sufficient vitamin D, it usually requires significantly higher amounts than 400 international units per day. Many experts are recommending 5,000 IU per day. My recommendation is to obtain a blood test to determine vitamin D status. If the breastfeeding mother is low, then the infant will be low as well.
Cod liver oil varies in quality. Many forms have way too much vitamin A and not enough vitamin D. I have taken cod liver oil myself in the past (for a few years). I much prefer fish oil capsules for omega-3 supplementation.
I use a vitamin D supplement in a pill (1,000 IU per day). My sister who lives in Connecticut requires 2,000 IU a day to maintain normal levels.
I wish you well,
GP
Vitamin D in winter? in Alaska?
Dear Ms. Smith–
Thank you for this question. Especially in winter in Minnesota, one needs to supplement with vitamin D.
Further north in Alaska, this is even more important.
Truly, one can be stark naked outside at noon in October through March in Minnesota and not make a drop of vitamin D. The sun is just too low.
The eskimos in Alaska get vitamin D through the seals/whales that they eat. For Minnesotans, I usually recommend a pill.
However, I am always happy to write a winter prescription of “one week, Hawaii, as needed.”
Take care,
GP
Sun Lamps?
TJ–
Thank you for writing. This is a very practical question.
The sun lamps for Seasonal Affective Disorder do not produce vitamin D.
Tanning booths which have UVB spectrum light waves can produce vitamin D. I do not recommend tanning booths.
As there are vitamin D receptors throughout the brain on the emotional and cognitive portions, there is good reason for keeping one’s vitamin D level in the normal range (greater than 32 ng/ml) year round.
Thus my push for vitamin D measurement and supplementation.
There are no controlled trials for SAD but there are many other positive health reasons to have normal vitamin D levels.
Cheers,
GP
How bout migraines?
Vitamin D and epileptic drugs
DJ–Yes, the anti-seizure drugs dilantin and phenobarbitone/phenobarbital are anti-vitamin D agents. Sodium valproate (valproic acid) is not.The newer drugs such as gabapentin are not.
however, even if one is not taking dilantin or phenobarbital, there is good reason to be on 1000 IU of vitamin D each day.
Use of anti-seizure medications is definitely associated with osteoporosis.
Minnesota’s own Dr. Kris Ensrud and colleagues at the VA have shown that women who take anti-epileptic medications lose bone at a rate twice that of peers who do not take medications for epilepsy.
So, for anyone on life-time treatment for epilepsy, ensuring normal vitamin D levels (greater than 32 ng/ml) will be important.
There is no data on vitamin D deficiency being a risk for increased seizures.
Take care,
GP
Safe vitamins?
John–yes, there are certifying bodies for vitamins and other supplements.
The best known is Consumerlab.com
http://www.consumerlab.com/
This was started by some former FDA scientists.
The Council for Responsible Nutrition (CRN)has been very active in this field.
http://www.crnusa.org/
For vitamin D, please note that the labels on milk bottles may not equal the contents. A study in the 1990’s found 28% of all skim milk samples contained no vitamin D at all.
GP
Sources of vitamin D? Sun? Supplements?
Dear TS–
Thank you for writing.
Yes, especially with Crohn’s or other forms of bowel disease, absorption of vitamin D can be difficult.
For this reason, I recommend checking blood levels by the 25-hydroxyvitamin D test.
Some people can be on high doses for years and not generate high levels.
For persons without known bowel disease who are deficient and cannot replace vitamin D very well, then testing for malabsorption, such as celiac disease, should be considered. This is a good time to partner with a physician.
Some people require high doses for long periods of time to achieve normal levels. Some people do not.
Finding the right dose for any one person requires the blood test for monitoring how much vitamin D one has.
I wish you well,
GP
Dear Dr.
I have Crohn’s disease at 51 (recently diagnosed) and am fat (how fair is that?)… You mentioned that Vitamin D for people with diseases like Crohn’s do not absorb the vitamin well. How do you get enough into the system?
My daughter also has seizures. After being on anti-seizure medications for years our Dr. just told us that she should be taking vitamin D when I asked about some other vitamins. If these medications are causing problems for bones, shouldn’t this be told to people right away?? Would love to know more about Vitamin D with anti- seizure medications.
Dear Confused about Healing–
There are many resources in Minnesota where one can partner with an informed health professional and address the range of options for treatment/prevention of health concerns.
I am proud to have joined the Institute for Health and Healing’s incredibly strong team this year as the medical director.
Please allow me to tell you about it.
The Institute for Health and Healing at Abbott Northwestern Hospital in Minneapolis, a part of the Allina system, is one of the nation’s foremost integrative medicine centers.
The Institute includes services for hospitalized patients, clinic patients and employees. We also have a very busy research program.
Our vision? The Institute seeks to transform health care by blending the art of healing and the science of curing to optimize the health of the whole person – mind, body and spirit.
The Institute came into existence in 2003 through the visionary support of the George Family Foundation and the Ted and Roberta Mann Foundation. Since its establishment, the Institute has continued to receive strong community and institutional support.
Since 2003, with this support, the Institute for Health and Healing has:
• Established a comprehensive integrative medicine process and program that blends the best evidence-based conventional therapies with healing therapies;
• Developed innovative, proactive models of care that embrace the strengths of the whole person — body, mind and spirit — and the families and communities in which we live;
• Grown to serve multiple inpatient centers of excellence with care services, education and now, starting in 2007, innovative clinical research.
Each and every month, the Institute’s team of integrative health professionals provides enhanced care in more than 1,500 inpatient visits and nearly 700 outpatient visits. The inpatient care teams provide personalized combinations of acupuncture, massage, guided imagery and energy work to nearly 15% of all patients hospitalized at Abbott-Northwestern.
We consistently reduce pain and anxiety for hospitalized patients by 40% without use of medications.
Patient, family, nurse and physician atisfaction ratings are sky high. People report choosing Abbott Northwestern for their care because, if needed when hospitalized, they can access integrative services (without charge). We are incresingly hearing that people choose doctors who work at Abbott for the same reason. People want to get better.
The Institute’s outpatient clinic not only offers these services but also biofeedback, two forms of traditional Asian medicine as well as both physician and interventional nutrition consultations. For patient groups, the Institute’s outpatient clinic provides numerous specialized health-education and self-care skills development programs.
I mention the clinic with a great deal of hesitation. The waiting list to get into the clinic is long. This is especially true for our incredible acupuncturists, healing coach and holistic nutritionist.
However, for your specific question CAH, you can access medical or Ayurvedic consultations in the outpatient clinic with Gary Carlson, MD and Marcia Meredith, CNP. I will have a consultation practice there beginning in January, 2009. Doug Danderand, PhD, has recently joined the staff as a “spiritual facilitator.” To schedule an appointment, please call 612-863-3333.
And, there are many, many classes that may be of interest. The list of classes can be found on our website http://www.abbottnorthwestern.com/ahs/anw.nsf/page/ihh_home
For more information, please check out the webpage: http://www.allina.com/ahs/anw.nsf/page/ihh_home
There you will find a link to our 2007 outcomes report.
Please allow me to also share that the Institute has a new state-of-the-art fitness center that supports these programs with advanced diagnostic tools and exercise equipment. All of these programs are staffed with exceptional professionals dedicated to the wellness and healing of the whole person.
To your health,
GP
I still don’t understand the reasoning behind not recommending tanning beds. If they emit UVB the same as the sun does, and the most natural way to get Vitamin D is through UVB rays, then why wouldn’t a tanning bed make sense for us in the winter? It just seems like a no-brainer for me but I’m concerned why you don’t recommend them. Thank you!
Hi,
can you talk about any connect with thyroid?
Hypo? Hyper?
Also, how about Diabetes, Hypertension,
Colon Cancer…
Thank You.
MS and vitamin D
Dear Lake Bluff Lisa–
Yes, this is Lake Bluff Greg. So nice to re-connect via the web!
The evidence linking MS with vitamin D is incredibly strong.
Just in the past month alone, there have been several important articles published in the journals Neurology and Multiple Sclerosis.
For this reason, for persons with MS or at risk of developing MS, monitoring serum levels with the 25-hydroxyvitamin D blood test will be important.
Measuring vitamin D is not the standard of care today but certainly will be tomorrow.
Hot off the press:
Smolders and colleagues at the University Hospital in Maastricht, the Netherlands, just published that vitamin D levels predict both relapse rate and disability in MS patients.
(Mulitple Sclerosis 2008 July 24, Epub ahead of print)
Kragt and colleagues at the VU University Medical Center in Amsterdam just published that higher levels of vitamin D are associated with a lower incidence of MS.
(Multiple Sclerosis 2008 August 13, Epub ahead of print)
The sheer numbers of articles from around the world that connect vitamin D with MS are nothing less than overwhelming.
My hope is that everyone with MS, or at risk of MS, will have serum levels of at least 32 ng/ml. This number may go up in future years…more studies are needed. This number appears to minimize bone loss and falls.
Take care,
GP
What are your findings or thoughts on Rheumatoid arthritis and vitamin D? Thank you for taking time out of your busy schedule to answer our questions.
Vitamin D and thyroid
There are vitamin D receptors on the thyroid gland. Why are they there? No one knows.
However, vitamin D regulates so much in the body that presumably the receptors are there for a reason.
From my experience, I do know that often when someone is low on thyroid, they are also low on vitamin D.
No study exists which shows that replacing vitamin D improves thyroid function. This would be a very interesting study to do.
Thyroid dysfunction is frequently due to an auto-immune process. As low vitamin D is correlated with auto-immune disease, such as Crohn’s, Lupus, MS, then there is another potential reason to ensure that everyone has normal vitamin D levels.
GP
I don’t have medical insurance and I can’t afford to see you. I am agoraphobic and housebound so I know I only see sunshine froma distance and as I was diagnosed with SLE I can’t be in it anyhow.
I doubt you answer this but I can go to a store and buy a Vitamin D supplement and I would like to try it but how much should I try?
vitamin D and osteoporosis/fractures/falls
Dear Beth L.–
Fifty percent of American women on osteoporosis medications are vitamin D deficient.
I cannot imagine how osteoporosis medications can work if no vitamin D is around to help.
My belief is that every woman should have a vitamin D level measured if they are at risk for osteoporosis or being treated for osteoporosis.
Recently, at the University of Wisconsin Osteoporosis Center, 65% of women being screened for osteoporosis were found to be vitamin D deficient.
Decisions to go on or off prescription medications should always be made in partnership with one’s physician.
One last comment: 50% of women who have hip fractures do not have osteoporosis. Balance, strength, flexibility are crucial. Anything which contributes to these, such as ballroom dancing or tai chi, will be important for prevention of nursing home admissions.
Numerous studies have shown that vitamin D supplementation in the elderly itself can reduce falls significantly…as much as 75%!
Take care,
GP
So, for osteoporosis, how much vitamin D?
1) measure vitamin D (25-hydroxyvitamin D blood test)
2) Supplement to achieve serum levels greater than 32 ng/ml.
GP
Re; MS & Vit D,
So then I can see why, we here in MN have a higher rate of MS…
Interesting.
I have a friend with MS, I will share this with her.
Thank you!
Vitamin D absorption
Dear Robin–
I am not aware of any data that shows that vitamin D absorption is blocked by other vitamins.
However, use of Miralax or other liquid constipation agents may reduce absorption.
As vitamin D is fat soluble, taking vitamin D with some fat containing food, such as whole milk yogurt, makes sense. This may increase absorption. And it will decrease any nausea should that be present.
Take care,
GP
Vitamin D and tanning beds
Dear Alan–
Dr. Michael Holick at Boston University wrote a book on vitamin D and made reference to the use of tanning beds.
Although a world class researcher, in fact the researcher who discovered the connection between vitamin D and psoriasis, he was fired from his job in the department of Dermatology.
For patients with fat malabsorption, exposure to a tanning bed for 30 to 50% of the time recommended for tanning (with sunscreen on the face) is an excellent means of treating and preventing vitamin D deficiency. This reduces the risk of skin cancers associated with ultraviolet B radiation.
Take care,
GP
Sources of vitamin D
Dear TS and Angie–
Besides sun exposure or supplementation, there is one other means of obtaining vitamin D.
Recently, Micheal Holick, MD, writing in the New England Journal of Medicine made this statement: Exposure to a tanning bed for 30 to 50% of the time recommended for tanning (with sunscreen on the face) is an excellent means of treating and preventing vitamin D deficiency. This reduces the risk of skin cancers associated with ultraviolet B radiation.
Take care,
GP
My husband has celiac disease. What should his serum levels be and how much vitaminD should he be taking?
Vitamin D and autism in the Somali Community
This is a big concern and much effort is being directed in Minnesota to see if the reports of increased rates are real and not the result of more people coming to Minneapolis for autism services.
Certainly, Somali women in Minnesota are at extremely high risk for severe vitamin D deficiency.
I should note however in my 2003 study of 150 people with chronic pain, the lowest vitamin D levels were in white women of child bearing age. No one in Minnesota is immune to vitamin D deficiency.
Now, back to autism. The developing brain is rich in vitamin D receptors. Increasing evidence points to low vitamin D being causally related to the development of schizophrenia. There is evidence that low vitamin D plays a role in depression. These have not been proven but deserve our close attention…particularly in communities we know are vitamin D deficient.
Recently, researchers from Oslo, Norway published data demonstrating severe vitamin D deficiency in children of immigrant women including Somali women. I wrote them about the incidence of autism in immigrant children in Norway. They are checking on that now.
My hope is that every child born in the United States will have sufficient vitamin D. Pre-natal vitamins are not sufficient at this time.
GP
Thank you so much for this incredible service - what a gold mine of information.
If one is vitamin D deficient, can it be treated with diet?
SStew
Have you seen any connection between Vitamin D and skin conditions - Keratosis Pilaris or itching associated with or without allergies?
Vitamins and proton pump inhibitors
Dear Lisa–
Thank you for this question. So many people take expensive proton pump inhibitors.
I am not aware of the need for stomach acid to absorb vitamin D. It may be needed for breaking up a vitamin tablet however.
PPIs definitely disrupt vitamin B12 metabolism over time. This may not resolve with taking oral vitamin B12. Shots are available.
Persons on long-term use of PPIs are at risk and should be periodically monitored for vitamin B12 status. Loss of B12 can present with nerve damage (peripheral neuropathy), decreased ability to think clearly, or anemia. Diagnosis may require obtaining an infrequently obtained blood test for methylcobalmin. An incomplete test is to check a serum B12 level or check for hyperhomocystinemia.
This is an important topic for partnering with your physician.
Take care,
GP
Vitamin D and A
Dear AV–
There is no particular reason to combine D with A.
I recommend people obtain vitamin A through vegetables which contain pre-vitamin A. This allows the body to follow its natural logic and produce the vitamin A it needs from the ingredients we send it.
For those persons who fear vegetables, supplements exist. However, we live in an agricultural state with great farmers markets and co-ops. My hope is that we will support our farmer neighbors and eat their vegetables for our vitamin A.
Many thanks,
GP
Vitamin D and stomach bypass
Dear Lori J and Saskia–
The most widely performed procedure for wieght loss is the Roux-en-Y gastric bypass operation.
Various types of anemia may complicate Roux-en-Y and commonly include deficiencies of iron, folate, and vitamin B12.
Iron deficiency is particularly common and may result from many mechanisms including poor intake, malabsorption, and mucosal bleeding from marginal ulceration. Sometimes iron deficiency is really hard to resolve.
Additionally, deficiencies of B-complex vitamins, ascorbic acid, and copper can exist.
All too frequently, women who undergo gastric bypass are vitamin D deficient prior to surgery.
If they also have hypertension, surgery will not treat their high blood pressure.
For women with high blood pressure and sufficient vitamin D prior to surgery, the surgery will cure their high blood pressure.
Monitoring vitamin D and nutritional status is very important in all persons who have had stomach bypasses.
Best wishes,
GP
HI - I have an adopted african american daughter who is 9 months old. i know i will need to supplement with vitamin D, especially over the winter. will the 1000iu in a liquid form be a good dose? thank you.
Vitamin D in complex conditions
Dear Joy–
Thank you for writing.
There are many integrative medicine practitioners in the Twin Cities with whom you could work on these complex issues.
There is good reason to make sure that vitamin D levels are normal in anyone with asthma and allergies. (see note above)
Vitamin D can certainly be measured by health professionals. Anyone with a complex medical condition should have normal levels so that all other treatments can do their best.
Common therapies for autism spectrum disorder may include omega-3 fatty acids but this is best done in partnership with a health professional.
Yeast is a very complex issue. I know that nutritionist Carolyn Denton, LN, and Ayurvedic practitioner Marcia Meredith, CNP, at the Institute for Health and Healing are quite good at working with this challenging issue. I know many other practitioners in town who also successfully address yeast concerns.
I wish you and your family well,
GP
Why aren’t all doctors as excited and involved as you are in helping us to live healthier? You are a rare breed, Dr. Greg. Thank you for being in our midst.
Vitamin D and rheumatoid arthritis
Thr further north one goes, the greater the risk for auto-immune diseases such as RA. The further north one goes, the greater the risk for low vitamin D.
Is there a connection between low vitamin D and auto-immune diseases?
More and more researchers are answering yes. In scientific terms, vitamin D is active in the downregulation of Th1-driven autoimmunity.
This is revolutionary. In addition to its role in calcium balance, which is all of what most physicians were taught in medical school, we now know that vitamin D has many other important preventive effects on the immune system, blood pressure, insulin resistance, and cancer. Activated vitamin D regulates the growth and differentiation of multiple cell types, regulates immune function and demonstrates anti-inflammatory properties.
Additionally, important immune cells in RA such as macrophages, dendritic cells, T cells and B cells have vitamin D receptors and can both produce and respond to activated vitamin D.
If these important immune cells have the receptors, then we should ensure that everyone has normal amounts of vitamin D.
For persons with RA, early detection and treatment of vitamin D deficiency is crucial as deficiency is common.
Vitamin D therapy may modify the increased risk of falls and fracture and possibly exert additional positive immune system effects on disease onset and activity.
Although more studies are needed,
we do know that greater intake of vitamin D has been associated with a lower risk of rheumatoid arthritis.
We also know that the lower the vitamin D level, the higher the disease activity of RA (in European patients).
In my mind, sufficient evidence exists now to support taking at least 1000 IU per day of vitamin D and for having a blood level checked at least once.
This may be particularly important for anyone on prednisone or on anti-TNF medications. Both medications are great for RA but prednisone is an anti-vitamin D agent and low vitamin D may increase the risk of infection in anti-TNF therapies.
To your health,
GP
Vitamin D and epilepsy
Dear SC–
Vitamin D levels are appropriate in all persons who do not have much sun exposure or are on phenobarb or dilantin or prednisone.
This sounds like most of the “frequent flyers” seen in hospitals, ERs and clinics.
Vitamin D is crucial for proper functioning of hip flexors/extensors…the muscles necessary for standing up from a chair, getting in and out of a car, going up stairs.
Just giving vitamin D significantly increases the strength capacity of these muscles.
Appropriate dosing would be based on her blood test results for vitamin D.
The goal is 32 ng/ml or more.
I would be happy to provide a replacement protocol to her doctors should they desire.
I wish both of you well,
GP
Vitamin D and St. Johns Wort
Dear Ms. Evans–
Thank you for writing. St. Johns Wort has been helpful for many people but has one characteristic which needs wider appreciation.
St. Johns Wort has the capacity to change blood levels of important medications…as well as vitamin D.
In some medications, levels go up and people can become toxic.
For some medications, levels go down and the medicine cannot do its work.
This includes transplant medications and birth control pills.
For vitamin D, the latter is true. St. Johns Wort revs up the vitamin D breakdown machinery which lowers the blood levels.
This can be overcome with additional vitamin D supplementation. How much? Best to follow the blood levels to ensure that they are greater than 32 ng/ml.
I wish you well,
GP
Vitamin D and migraines/headaches
Dear Ms. Withers and Sally–
Dr. Thys-Jacobs at Mount Sinai Hospital in New York City first reported on the efficacy of vitamin D and calcium for migraines and menstrual migraines in two separate articles in the journal entitled Headache in 1994.
Since then, numerous reports exist in the literature and circulate among physicians regarding vitamin D and calcium for all sorts of headaches.
It may not surprise you that I measure vitamin D levels in persons with constellations of unusual symptoms, such as “squishy headaches”, or who have not been helped by extensive testing and treatment.
I also have seen great results with use of other supplements such as magnesium, high dose riboflavin or co-Q10. Best to partner with an experienced integrative physician. Many exist in Minnesota. I work with Gary Carlson, MD, at the IHH and know that he gets great results in the persons he sees. He will often be able to identify additional opportunties for any person for preventing and reducing the severity of headaches.
I wish you well,
GP
Vitamin D and psoriasis
Dear Lisa–
Congratulations on your relief from pain!
And yes,
Psoriasis is a vitamin D related issue.
Vitamin D regulates the genes that control cellular proliferation, differentiation and apoptosis…the very things that go awry in the skin with psoriasis.
There are special topical vitamin D treatments. Also going in the light booth ups vitamin D, I believe.
Certainly sun can be helpful.
And certainly stress management techniques such as mindfulness based stress reduction (MBSR) can be very helpful.
This was first shown in this 1998 study by Jon Kabat-Zinn and colleagues at the University of Massachusetts: Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA).
The conventional establishment did not believe that thought/stress reduction could have any affect. But now ten years later, the proof is so overwhelming that even the most conservative of physicians accept it.
Vitamin D is easy to measure and supplement. MBSR requires clear intention for best results. One needs to be motivated to incorporate it into one’s life.
Such skills are taught at the Institute for Health and Healing where I work as well in many other locations throughout Minnesota.
I wish you both well,
GP
Dear Confused about Healing–
There are many resources in Minnesota where one can partner with an informed health professional and address the range of options for treatment/prevention of health concerns.
I am proud to have joined the Institute for Health and Healing’s incredibly strong team this year as the medical director.
Please allow me to tell you about it.
The Institute for Health and Healing at Abbott Northwestern Hospital in Minneapolis, a part of the Allina system, is one of the nation’s foremost integrative medicine centers.
The Institute includes services for hospitalized patients, clinic patients and employees. We also have a very busy research program.
Our vision? The Institute seeks to transform health care by blending the art of healing and the science of curing to optimize the health of the whole person – mind, body and spirit.
The Institute came into existence in 2003 through the visionary support of the George Family Foundation and the Ted and Roberta Mann Foundation. Since its establishment, the Institute has continued to receive strong community and institutional support.
Since 2003, with this support, the Institute for Health and Healing has:
• Established a comprehensive integrative medicine process and program that blends the best evidence-based conventional therapies with healing therapies;
• Developed innovative, proactive models of care that embrace the strengths of the whole person — body, mind and spirit — and the families and communities in which we live;
• Grown to serve multiple inpatient centers of excellence with care services, education and now, starting in 2007, innovative clinical research.
Each and every month, the Institute’s team of integrative health professionals provides enhanced care in more than 1,500 inpatient visits and nearly 700 outpatient visits. The inpatient care teams provide personalized combinations of acupuncture, massage, guided imagery and energy work to nearly 15% of all patients hospitalized at Abbott-Northwestern.
We consistently reduce pain and anxiety for hospitalized patients by 40% without use of medications.
Patient, family, nurse and physician atisfaction ratings are sky high. People report choosing Abbott Northwestern for their care because, if needed when hospitalized, they can access integrative services (without charge). We are incresingly hearing that people choose doctors who work at Abbott for the same reason. People want to get better.
The Institute’s outpatient clinic not only offers these services but also biofeedback, two forms of traditional Asian medicine as well as both physician and interventional nutrition consultations. For patient groups, the Institute’s outpatient clinic provides numerous specialized health-education and self-care skills development programs.
I mention the clinic with a great deal of hesitation. The waiting list to get into the clinic is long. This is especially true for our incredible acupuncturists, healing coach and holistic nutritionist.
However, for your specific question CAH, you can access medical or Ayurvedic consultations in the outpatient clinic with Gary Carlson, MD and Marcia Meredith, CNP. I will have a consultation practice there beginning in January, 2009. Doug Danderand, PhD, has recently joined the staff as a “spiritual facilitator.” To schedule an appointment, please call 612-863-3333.
And, there are many, many classes that may be of interest. The list of classes can be found on our website http://www.abbottnorthwestern.com/ahs/anw.nsf/page/ihh_home
For more information, please check out the webpage: http://www.allina.com/ahs/anw.nsf/page/ihh_home
There you will find a link to our 2007 outcomes report.
Please allow me to also share that the Institute has a new state-of-the-art fitness center that supports these programs with advanced diagnostic tools and exercise equipment. All of these programs are staffed with exceptional professionals dedicated to the wellness and healing of the whole person.
To your health,
GP
Dear Cheshire–
Thank you for writing.
Vitamin D is important in so many medical concerns because it is such a powerful steroid hormone in our body.
Its much more than a vitamin.
Its in a class by itself. Its much more similar to powerful steroid hormones like estrogen or testosterone or thyroid…when one is low on any of these three, one can feel really bad.
The same can be true with vitamin D.
Most people who are low, however, do not have symptoms.
There are vitamin D receptors throughout the brain on both the cognitive and emotional centers.
I recommend that Minnesotans supplement with at least 1,000 international units (IU) per day. For people who can, I recommend checking a vitamin D level at least once in their life.
The cost of over the counter vitamin D at 1,000 IU per day is 5 cents.
I wish you well,
GP
Vitamin D and celiac disease
Dear Ms. Henderson–
Celiac disease is often associated with very low vitamin D levels.
This can be bypassed by sun exposure or by tanning (see comments above).
All persons with celiac disease deserve a vitamin D level check. The goal is a blood level of 25 hydroxy vitamin D greater than 32 ng/ml and a PTH level of 50 or less.
Doctors will often check a PTH level in persons with very low vitamin D. This can help guide replacement.
Oral replacement guidelines in celiac disease do not exist. There is wide variability so measuring the levels at periodic intervals make sense.
I wish your husband well,
GP
Vitamin D and diet
Dear SStew–
Thank you for this question.
Vitamin D is hard to get in the diet.
To obtain 1000 IU of vitamin D, one needs to drink close to three quarts a day of milk!
Or eat an entire box of fortified cereal.
Or both.
The point is that food is not a good source of vitamin D for persons in Minnesota. Most of us don’t eat whale or seal or certain unfarmed ocean fish or drink enough milk or eat enough cheerios to make a difference.
This is why safe sunning is so important from April to September and why supplementation in the winter is so necessary.
Take care,
GP
With much gratitude
Dear Karen F and SStew–
Thank you for your kind words.
And thank you everyone for understanding how the focus on fundamentals first makes so much sense for the public’s health.
True primary care is what we can do for ourselves. The mission of the Institute for Health and Healing at Abbott Northwestern Hospital is to enable patients to discover and develop their inner strengths for self-care and self-healing.
Vitamin D or supplements in general are just a very small portion of the low-cost, low-tech approaches with big impacts on illness.
Spending the day blogging we see as one means of getting the word out about new approaches to wellness and prevention…for persons with and without medical diagnoses.
To your health,
GP
Vitamin D supplementation in children
Dear Seth–
Thank you for writing. Yes, vitamin D at 1000 international units is believed to be safe for children.
The current recommendations from the American Academy of Pediatrics is lower.
There are no good ways of monitoring vitamin D status except by a blood test.
We do know that at least 400 IU is needed every day to keep levels from falling into levels less than 21 ng/ml.
The goal is to have levels greater than 32 ng/ml.
Toxicity is not seen until levels are at least 100 ng/ml.
So, safe sunnning in the summer, supplementation in the winter.
I wish you both well,
GP
Your message about vitamin D is badly needed. I asked my doctor about vitamin D supplementation repeatedly during pregnancy and lactation, and I was always told just to get plenty of fruits and vegetables, which obviously do not contain vitamin D. Recently a chiropractor recommended that I take both increased Vitamin D and some iodine. Is there any relationship between Vitamin D and iodine in the body? Or do some of their deficiency symptoms overlap by coincidence? Perhaps iodine is a completely different subject but I was wondering if your research involves this nutrient. Obviously, our soil is fairly deficient in iodine in the Midwest, especially for vegetarians and others who eat little seafood. Thank you!
Vitamin D and Colon Cancer
Dear SJ–
This is important for Minnesotans.
Colon Cancer Kills…let’s minimize the risk.
What is the evidence?
Both prospective and retrospective epidemiologic studies show that low vitamin D is associated with a 30 to 50% increased risk of colon, prostate, and breast cancer. And, low vitamin D levels are associated with a greater risk of dying from these cancers.
I do not want to see anyone die from cancer with a low vitamin D level.
The Nurses’ Health Study of 32,826 women showed that the risk of colon cancer was higher the lower the blood level of vitamin D.
For the epidemiologists reading this, the odds ratio at 16.2 ng/ml was 1.0, and the odds ratio at 39.9 ng/ml was 0.53; P<0.01).
In a study of 1,954 men, there was a direct relationship of low vitamin D and increased risk of colorectal cancer.
There was a relative risk of 1.0 when vitamin D intake was 6 to 94 IU per day and a relative risk of 0.53 when the intake was 233 to 652 IU per day, P<0.05.
For the participants in the Women’s Health Initiative who at baseline had a 25-hydroxyvitamin D level of less than 12 ng/ml, they had a 253% increase in the risk of colorectal cancer over a follow-up period of 8 years.
For persons at risk of cancer because of genetics or family history, vitamin D supplementation to greater than 40 ng/ml makes sense.
GP
which form vitamin D is better the daily tablets or monthly injections
Vitamin D and pregnancy
Dear RLS–
Yes, there is no possible vitamin D in any fruit or vegetable.
And, sadly, even with supplementation, only a small percentage of women and babies are vitamin D sufficient at the time of birth in the US.
Further research is required to determine the optimal timing and dosing of vitamin D in pregnancy.
Current pre-natal vitamins are completely inadequate.
All women who intend to be pregnant or are pregnant should obtain 1000 international units of vitamin D each day.
For persons at significantly greater risk of low vitamin D, such as Somali women or women who work indoors, then obtaining a vitamin D level at the first prenatal visit makes great sense.
As for iodine, this is so rarely tested. There is a presumption of iodine sufficiency as salt is supplemented.
A recent study of 168 pregnant women tested for iodine levels and for thyroid function. They found normal iodine levels but 14 women with reduced thyroid function. There was no correlation between the iodine levels and the decreased thyroid function.
(Jesenik Hospital, Czech Republic)
Take care,
GP
Vitamin D forms
Dear Pete L–
Pills are handy because there is greater control.
Once a shot is given, there is no taking it back…should the need arise.
Frequently in Europe, nursing home patients are given shots on a regular basis. This is very convenient and very safe.
For persons with absorption problems, a shot makes sense…or safe sunning in the summer.
Liquid forms of vitamin D also exist.
Take care,
GP
Dear Confused about Healing–
There are many resources in Minnesota where one can partner with an informed health professional and address the range of options for treatment/prevention of health concerns.
I am proud to have joined Abbott Northwestern Hospital’s Institute for Health and Healing’s incredibly strong team this year as the medical director.
Please allow me to tell you about it.
The Institute for Health and Healing at Abbott Northwestern Hospital in Minneapolis, a part of the Allina Hospitals & Clinics, is now the largest hospital-based integrative medicine program in the country. The Institute provides services for hospitalized patients, clinic patients and employees. We also have a very busy research program.
Our vision? The Institute seeks to transform health care by blending the art of healing and the science of curing to optimize the health of the whole person – mind, body and spirit.
The Institute came into existence in 2003 through the visionary support of the George Family Foundation and the Ted and Roberta Mann Foundation. Since its establishment, the Institute has continued to receive strong community and institutional support.
The Institute has:
• Established a comprehensive integrative medicine process and program that blends the best evidence-based conventional therapies with healing therapies;
• Developed innovative, proactive models of care that embrace the strengths of the whole person — body, mind and spirit — and the families and communities in which we live;
• Grown to serve multiple inpatient centers of excellence with care services, education and now, starting in 2007, innovative clinical research.
Each and every month, the Institute’s team of integrative health professionals provides enhanced care in more than 1,500 inpatient visits and more than outpatient visits. The inpatient care teams provide personalized combinations of acupuncture, massage, guided imagery and energy work to nearly 15 percent of all patients hospitalized at Abbott Northwestern.
We consistently reduce pain and anxiety for hospitalized patients by 40 percent without use of medications.
The Institute’s Outpatient Clinic not only offers these services but also biofeedback, two forms of traditional Asian medicine as well as both physician and interventional nutrition consultations. For patient groups, the Institute’s Outpatient Clinic provides numerous specialized health-education and self-care skills development programs.
I mention the clinic with a great deal of hesitation. For some of the services at our Outpatient Clinic, there is a waiting list. This is especially true for our incredible acupuncturists, healing coach and holistic nutritionist.
However, for your specific question CAH, you can access medical or Ayurvedic consultations in the outpatient clinic with Gary Carlson, MD and Marcia Meredith, CNP. I will have a consultation practice there beginning in January, 2009. Doug Danderand, PhD, has recently joined the staff as a “spiritual facilitator.” And, there are many, many classes there that may be of interest. The clinic’s phone number is 612-863-3333.
Classes can be accessed on the web
http://www.allina.com/ahs/anw.nsf/page/ihh_home
The Institute also has a new state-of-the-art fitness center, the LiveWell Fitness Center, that supports these programs with advanced diagnostic tools and exercise equipment. All of these programs are staffed with exceptional professionals dedicated to the wellness and healing of the whole person.
For more information, please check out the webpage: http://www.allina.com/ahs/anw.nsf/page/ihh_home
There you will find a link to our 2007 outcomes report.
Take care,
GP
Dear Confused about Healing–
There are many resources in Minnesota where one can partner with an informed health professional and address the range of options for treatment/prevention of health concerns.
I am proud to have joined Abbott Northwestern Hospital’s Institute for Health and Healing’s incredibly strong team this year as the medical director.
Please allow me to tell you about it.
The Institute for Health and Healing at Abbott Northwestern Hospital in Minneapolis, a part of the Allina Hospitals & Clinics, is now the largest hospital-based integrative medicine program in the country. The Institute provides services for hospitalized patients, clinic patients and employees. We also have a very busy research program.
Our vision? The Institute seeks to transform health care by blending the art of healing and the science of curing to optimize the health of the whole person – mind, body and spirit.
The Institute came into existence in 2003 through the visionary support of the George Family Foundation and the Ted and Roberta Mann Foundation. Since its establishment, the Institute has continued to receive strong community and institutional support.
For more information, please check out the webpage: http://www.allina.com/ahs/anw.nsf/page/ihh_home
There you will find a link to our 2007 outcomes report.
Take care,
GP
What about the cell wall deficient bacteria that has been proven to cause chronic disease according to Professor Trevor Marshall, PhD? Dr. Marshall’s extensive research as a biomedical researcher shows that Vitamin D’s steroidal effects allow this bacteria to grow even more and contribute even more to long-term disease and illness. See http://www.bacteriality.com and http://www.marshallprotocol.com.
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