Vitamin D – Expert’s Forum

Rufus Greenbaum – UK data overview
● UK definition of Vitamin D Deficiency: <25nmol/L (<10ng/mL)
● UK average = 35-65 nmol/L from Winter-Summer
● Need 75nmol/L for good bone health
● Need 100-150nmol/L for good general health
● UK testing shows 35% of population are deficient <25nmol/L
● UK hospitals see children with seizures and heart failure due to low Vitamin D
● Short, medium and long-term problems, leading to muscle, bone and auto-immune diseases

 

Professor Michael Holick – A D-lightful story for good health
● Importance of Vitamin D: The crucial role of vitamin D in overall health, highlighting its association with various health conditions beyond rickets.
● Vitamin D Deficiency: The widespread prevalence of vitamin D deficiency, particularly in urbanized populations and individuals with limited sun exposure.
● Sun Exposure and Vitamin D: Sunlight is the primary source of vitamin D, but appreciate the risks of excessive sun exposure and the importance of sun protection.
● Vitamin D Deficiency and Health Risks: Vitamin D deficiency is associated with an increased risk of various health issues, including diabetes, multiple sclerosis, cardiovascular disease, and certain cancers.
● Vitamin D Recommendations: Recommendations for vitamin D supplementation, suggesting higher doses than the current official guidelines.
● Vitamin D and Pregnancy: The importance of adequate vitamin D intake during pregnancy and lactation, emphasizing the potential benefits for both mother and child.
● Vitamin D and Children: The importance of vitamin D for children, particularly in preventing rickets and promoting healthy bone development.
Vitamin D Testing: The importance of measuring vitamin D levels through blood tests to assess individual needs and monitor supplementation.
● Challenges in Vitamin D Research: Challenges in vitamin D research, including conflicting recommendations and limited understanding of optimal levels.
● Public Health Message: Need public health campaigns to promote safe sun exposure and encourage adequate vitamin D intake through diet and supplementation.

 

Carole Baggerley – Grass Roots Health – Breast Cancer
● Widespread impact of breast cancer, noting that almost everyone in the audience knows someone affected by it.
● Significant cost of breast cancer, citing an estimated cost of $3.6 billion per year in the US.
● Increasing proportion of the elderly population, which will lead to a rise in cancer cases and other age-related health issues.
● Limited Life Expectancy Gains from Cancer Treatment: She contrasts the significant gains in life expectancy from cardiovascular disease treatment with the relatively small gains from cancer treatment, emphasizing the need for alternative approaches.
● Personal Motivation: She shares her personal experience with breast cancer and osteoporosis, which motivated her research into the role of vitamin D in cancer prevention.
● Vitamin D and Cancer Risk Reduction: She presents several studies showing a significant association between higher vitamin D levels and reduced breast cancer risk, including a 50-80% risk reduction.
● Mechanism of Action: She explains Dr. Garland’s theory on how vitamin D may prevent cancer by strengthening cell adhesion and inhibiting cancer cell growth.
● Grassroots Health Study: She describes the Grassroots Health study, a large-scale citizen science project investigating the impact of vitamin D supplementation on health outcomes.
● Importance of Serum Vitamin D Levels: She emphasizes the importance of measuring individual blood serum vitamin D levels to determine optimal supplementation dosages.
● Call to Action: Carole Baggerley concludes with a call to action, urging individuals and healthcare professionals to prioritize vitamin D testing and supplementation to improve public health and reduce the burden of cancer.

 

Dr David Grimes – Clinical experiences with Vitamin D in a UK hospital
Introduction to Vitamin D Deficiency (0:00 – 4:20)
● Vitamin D deficiency and its potential health consequences. He discusses the various factors that can contribute to low vitamin D levels, such as lack of sun exposure, dietary deficiencies, and certain medical conditions.

● Prevalence of Vitamin D Deficiency in Blackburn (4:20 – 8:40)
Dr. Grimes presents data from his own patient population in Blackburn, showing that a significant proportion have low vitamin D levels. He highlights specific cases where vitamin D deficiency contributed to health problems such as osteomalacia, chronic diseases, and fatigue.

● The Importance of Vitamin D (8:40 – 13:00)
The crucial role of vitamin D in various bodily functions and its potential impact on overall health and mortality. He cites research showing a link between low vitamin D levels and increased mortality risk.

● Treatment and Challenges (13:00 – 17:20)
The challenges of treating vitamin D deficiency, including the cost of vitamin D supplements and the need for ongoing monitoring. He also discusses the importance of lifestyle changes, such as increasing sun exposure and consuming vitamin D-rich foods.

● Future Research (17:20 – 21:40)
The need for further research to better understand the role of vitamin D in various diseases and to develop more effective treatment strategies. He also discusses the importance of raising awareness about vitamin D deficiency and advocating for improved access to testing and treatment.

● The Role of Sunlight in Vitamin D Synthesis (21:40 – 25:00)
The role of sunlight in vitamin D synthesis. He explains how the skin produces vitamin D when exposed to sunlight, and how factors such as skin color, time of day, and geographic location can affect vitamin D production.

● Dietary Sources of Vitamin D (25:00 – 29:20)
Various dietary sources of vitamin D, including fatty fish, egg yolks, fortified milk, and fortified cereals. He also discusses the importance of consuming a balanced diet that includes a variety of foods.

● Vitamin D Supplements (29:20 – 33:40)
Use of vitamin D supplements and the importance of taking the correct dosage. He also discusses the potential risks of taking too much vitamin D.

● The Importance of Regular Blood Tests (33:40 – 38:00)
The importance of getting regular blood tests to check vitamin D levels. He recommends getting a blood test at least once a year, and more often if you are at risk of vitamin D deficiency.

● Conclusion (38:00 – 42:45)
Dr. Grimes concludes the video by summarizing the key points discussed and emphasizing the importance of taking steps to prevent and treat vitamin D deficiency.

Dr. David Grimes is a consultant Gastroenterologist at Blackburn Hospital in the UK.
He has written about the importance of Vitamin D for the developing foetus and the implications for infections, diabetes, heart disease, liver disease and Crohn’s disease. More at: www.vitamindandcholesterol.com

In this video, Dr. David Grimes, a clinical doctor with over 50 years of experience, discusses his clinical experiences with vitamin D deficiency in a UK hospital. He highlights the high prevalence of vitamin D deficiency in Blackburn, a region with a high standardized mortality ratio due to geographical, social, and ethnic factors. Dr. Grimes presents data from his own patient population, showing that a significant proportion have low vitamin D levels and discusses specific cases where vitamin D deficiency contributed to health problems. He emphasizes the crucial role of vitamin D in various bodily functions and its potential impact on overall health and mortality. Dr. Grimes also discusses the challenges of treating vitamin D deficiency, including the cost of vitamin D supplements and the need for ongoing monitoring. He concludes by emphasizing the importance of raising awareness about vitamin D deficiency and advocating for improved access to testing and treatment.

 

Oliver Gillie – Vitamin D Deficiency in the UK – North to South
● Introduction (0:00-2:00):  Oliver Gillie introduces the topic of vitamin D insufficiency in the UK and criticizes the government’s current policy as inadequate. He highlights the UK’s climate and lifestyle factors that contribute to vitamin D deficiency.
Sunshine and Vitamin D (2:00-5:00):  He discusses the geographical variations in sunshine across the UK, emphasizing the lower levels of sunlight in Scotland compared to England. He presents data on vitamin D levels in different regions of the UK, highlighting the high prevalence of deficiency in Scotland.
● The “Scottish Effect” (5:00-7:00):  He introduces the “Scottish Effect,” which refers to the higher mortality rates in Scotland compared to England. He discusses potential causes of this effect, including vitamin D insufficiency.
Global Trends (7:00-9:00):  He discusses the global trend of higher disease rates in northern latitudes and explores potential explanations, including the role of sunlight and vitamin D.
● Government Policy Failures (9:00-15:00):  Oliver Gillie outlines five key failures of the UK government’s public health policy on vitamin D:
– Failure to recommend vitamin D supplements for healthy adults.
– Inadequate advice on vitamin D supplementation for breastfed babies.
– Ineffective implementation of the Healthy Start scheme for providing vitamin D supplements to low-income families.
– Lack of food fortification with vitamin D.
– Misleading advice from cancer charities regarding sun exposure.
● Sun Avoidance and Health Risks (15:00-18:00):  He discusses the potential health consequences of excessive sun avoidance, including vitamin D deficiency and increased risk of chronic diseases. He criticizes the previous advice from cancer charities to avoid sun exposure.
● Sun Safe Advice (18:00-20:00):  He presents his own “sun safe” advice, which encourages safe sun exposure while avoiding sunburn.
● Celebrity Examples (20:00-24:00):  He uses examples of celebrities to illustrate the impact of sun exposure on health, including the potential benefits of moderate sun exposure and the risks of excessive sun avoidance.
● Case Studies (24:00-27:00):  He presents case studies of individuals affected by vitamin D deficiency, including a famous cellist who developed multiple sclerosis and a renowned scientist who benefited from vitamin D supplementation.
● Conclusion (27:00-28:46):  Oliver Gillie summarizes the key problems related to vitamin D insufficiency in the UK and emphasizes the need for government action to address this issue. He highlights the potential benefits of improved vitamin D status for public health and the economic savings that could be achieved.

 

Dr. William B. Grant – the health impact of improving vitamin D levels
● Vitamin D and Disease: Dr. Grant discusses the link between vitamin D deficiency and various diseases, including cardiovascular disease, cancer, respiratory diseases, diabetes, tuberculosis, Alzheimer’s disease, falls, Parkinson’s disease, meningitis, and multiple sclerosis. (0:00-0:45)
● Types of Studies: He explains the different types of epidemiological studies used to investigate the link between vitamin D and disease, including nested case-control studies, case-control studies, cross-sectional studies, and ecological studies. (0:45-3:00)
● Importance of Vitamin D: Dr. Grant emphasizes the importance of vitamin D, particularly for those with darker skin, those who live in areas with less sunlight, and those who spend most of their time indoors. (3:00-4:00)
● Vitamin D and Cardiovascular Disease: He highlights the potential role of vitamin D in reducing the risk of cardiovascular disease, citing observational studies that have found an association between lower vitamin D levels and higher risk. (4:00-6:00)
● Vitamin D and Cancer: Dr. Grant discusses the link between vitamin D and cancer, particularly colon, breast, and prostate cancer. He mentions ecological studies that have shown a correlation between lower vitamin D levels and higher rates of these cancers. (6:00-10:00)
● Vitamin D and Respiratory Diseases: He discusses the potential role of vitamin D in reducing the risk of respiratory diseases, including chronic obstructive pulmonary disease (COPD) and respiratory infections such as influenza and pneumonia. (10:00-12:00)
● Vitamin D and Other Diseases: Dr. Grant also discusses the potential role of vitamin D in reducing the risk of other diseases, including Alzheimer’s disease, tuberculosis, falls, Parkinson’s disease, meningitis, and multiple sclerosis. (12:00-18:00)
● Economic Impact: He discusses the potential economic impact of vitamin D deficiency, including increased healthcare costs and lost productivity. (18:00-20:00)
● Future Research: Dr. Grant emphasizes the need for further research to better understand the role of vitamin D in health and disease. (20:00-22:00)
● Public Awareness: He highlights the importance of public awareness about the importance of vitamin D and the need to ensure that everyone has access to adequate levels of this essential nutrient. (22:00-25:00)

 

Dr. Reinhold Vieth – benefits and dangers of supplementing with Vitamin D.

This is a lecture by Dr Reinhold Vieth, a Professor in the Departments of Nutritional Sciences and Laboratory Medicine and Pathology at the University of Toronto.

 

10-Point Overview of the Talk

• Vitamin D’s Role: Vitamin D is a hormone precursor essential for calcium absorption and bone health, with broader effects on immunity, cancer prevention, and cardiovascular health.
• Deficiency Prevalence: Modern lifestyles (less sun exposure, sunscreen use) lead to widespread deficiency, with 25(OH)D levels < 30 nmol/L considered deficient.
• Optimal Levels: Dr. Vieth recommends 25(OH)D levels of 75–100 nmol/L (30–40 ng/mL) for optimal health, supported by studies showing reduced disease risk.
• Supplementation Dosing: Achieving optimal levels often requires 2000–4000 IU/day, far higher than the RDA (600–800 IU/day), especially for obese or darker-skinned individuals.
• Safety of High Doses: Doses up to 10,000 IU/day are safe for most adults, with Vieth’s studies showing no toxicity at these levels over months.
• Toxicity Threshold: Toxicity (hypercalcemia, kidney damage) occurs only at extreme doses (>40,000 IU/day) or 25(OH)D > 375 nmol/L, which is rare.
• Non-Skeletal Benefits: Higher vitamin D levels are linked to lower risks of autoimmune diseases, cancers (e.g., breast, colon), infections, and depression.
• Sun Exposure Equivalent: Midday sun exposure (15–30 minutes for light skin) can produce 10,000–20,000 IU, but is often insufficient in northern latitudes.
• Guideline Critiques: Vieth challenges conservative guidelines (e.g., IOM’s 4000 IU/day upper limit) as overly cautious, ignoring evidence of safety and benefits at higher doses.
• Practical Advice: Routine supplementation of 2000–4000 IU/day is safe and effective for most; testing 25(OH)D is useful but not mandatory.

 

Introduction (0:00–5:00)

• Dr. Reinhold Vieth is introduced as an expert on vitamin D, with extensive research on its metabolism and clinical applications.
• The lecture aims to address the benefits of vitamin D supplementation, its potential risks (toxicity), and the controversy surrounding optimal dosing.
• Vieth emphasizes that vitamin D is not just a vitamin but a hormone precursor critical for numerous physiological processes beyond bone health.

Vitamin D Basics (5:00–10:00)

• Vitamin D is synthesized in the skin via UVB exposure or obtained through diet/supplements (D2 or D3).
• It is converted to 25-hydroxyvitamin D (25(OH)D) in the liver, the primary circulating form measured in blood tests, and then to 1,25-dihydroxyvitamin D (active form) in the kidneys.
• Deficiency is Alberta defined as serum 25(OH)D levels below 30 nmol/L (12 ng/mL); sufficiency is above 75–100 nmol/L (30–40 ng/mL).
• Vieth notes that modern lifestyles (indoor living, sunscreen use) reduce natural vitamin D synthesis, increasing deficiency risk.

Benefits of Vitamin D (10:00–25:00)

• Bone Health: Vitamin D enhances calcium absorption, preventing rickets (children) and osteomalacia/osteoporosis (adults).
• Non-Skeletal Benefits: Emerging evidence links higher 25(OH)D levels to reduced risk of:
  • Autoimmune diseases (e.g., multiple sclerosis, type 1 diabetes).
  • Cancers (e.g., breast, colon, prostate).
  • Cardiovascular disease.
  • Infections (e.g., influenza, tuberculosis).
  • Mental health disorders (e.g., depression).
• Vieth cites studies showing that 25(OH)D levels of 75–100 nmol/L correlate with lower disease risk compared to lower levels.
• Example: A study showed that women with 25(OH)D > 100 nmol/L had a 50% lower breast cancer risk than those < 50 nmol/L.

Vitamin D Supplementation (25:00–35:00)

• Recommended Dietary Allowance (RDA) is 600–800 IU/day (US/Canada), but Vieth argues this is too low for most adults.
• Dosing to achieve 75–100 nmol/L often requires 2000–4000 IU/day, depending on body weight, skin type, and baseline levels.
• Vieth presents data from his studies:
  • 4000 IU/day for 6 months raised 25(OH)D from ~50 to ~100 nmol/L without toxicity.
  • 10,000 IU/day for months is generally safe for most adults.
• Sun exposure equivalent: 15–30 minutes of midday sun (for light-skinned individuals) can produce 10,000–20,000 IU.
• Supplements (D3) are inexpensive and effective; D2 is less potent.

Vitamin D Toxicity (35:00–50:00)

• Toxicity (hypercalcemia, kidney damage) is rare and occurs at very high doses (>40,000 IU/day for months) or 25(OH)D > 375 nmol/L (150 ng/mL).
• Vieth debunks myths:
  • Historical cases of toxicity (e.g., 1950s fortified milk errors) involved massive doses (100,000+ IU/day).
  • Modern cases are extremely rare and often involve manufacturing errors or intentional overdosing.
• Symptoms of toxicity: nausea, vomiting, weakness, kidney stones, and elevated blood calcium (>2.75 mmol/L).
• Vieth’s studies: No toxicity observed at 10,000 IU/day for 5 months; 25(OH)D levels plateaued at ~225 nmol/L.
• Safety margin is wide: Toxicity requires doses 10–100 times higher than typical supplementation (1000–4000 IU/day).

Controversies and Guidelines (50:00–60:00)

• Institute of Medicine (IOM) 2011 Report: Set upper limit at 4000 IU/day, which Vieth criticizes as overly conservative, ignoring evidence of safety at higher doses.
• Endocrine Society Guidelines: Suggest 1500–2000 IU/day for adults, with upper limit of 10,000 IU/day.
• Vieth argues that fear of toxicity stifles higher-dose recommendations, despite data showing benefits of 25(OH)D > 75 nmol/L.
• Individual variability: Obese individuals, darker-skinned people, and those with malabsorption need higher doses.
• Testing 25(OH)D levels is ideal but not always necessary; 2000–4000 IU/day is a safe default for most.

Conclusion and Q&A (60:00–62:52)

• Vieth advocates for higher vitamin D intake (2000–4000 IU/day) to achieve 25(OH)D levels of 75–100 nmol/L for optimal health.
• Toxicity is a minimal concern at these doses; benefits far outweigh risks for most people.
• Public health message: Increase supplementation and safe sun exposure to address widespread deficiency.
• Q&A (brief): Addresses concerns about kidney stones (minimal risk at <10,000 IU/day), interactions with medications (rare), and vitamin D in pregnancy (safe and beneficial).

 

Critical Perspective: While Vieth’s evidence is compelling, some critics argue that non-skeletal benefits (e.g., cancer prevention) require more randomized controlled trials for definitive proof. The IOM’s conservative stance reflects this caution.

 

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