Vitamin D Newsletter

[Guest guest]

*Quest Diagnostics and Cardiovascular Disease*

This is a periodic newsletter from the Vitamin D Council, a non-profit

trying to end the epidemic of vitamin D deficiency. If you want to

unsubscribe, go to the end of this newsletter. If you are not subscribed,

you can do so on the Vitamin D Council’s

website.<http://list.netatlantic.com/t/51207408/88831687/104386/0/>

The ls of Internal Medicine published two important reviews this month.

In the first review, Dr. Anastassios Pittas and colleagues from Tufts

University reviewed 106 articles and combined the 32 quality studies, a

meta-analysis, looking at “cardiometabolic” outcomes such as diabetes,

hypertension and cardiovascular disease. Their conclusion: “Lower vitamin D

status seems to be associated with increased risk for hypertension and

cardiovascular disease, but we do not yet know whether vitamin D supplements

will affect clinical outcomes.” Read on.

Pittas AG, et al. Systematic review: Vitamin D and cardiometabolic outcomes.

Ann Intern Med. 2010 Mar

2;152(5):307-14.<http://list.netatlantic.com/t/51207408/88831687/126827/0/>

The second ls of Internal Medicine review, by Dr. Lu Wang and colleagues

at Harvard, looked at studies of vitamin D supplementation and found two

randomized placebo controlled trials to combine. Dozens of different types

of studies have looked at vitamin D and cardiovascular outcomes. The

latitude studies are clear, the closer you live to the equator, the less

cardiovascular disease. The dietary studies are mixed, because vitamin D is

not contained in the diet, at least in significant amounts. The

epidemiological studies are clear.

Wang L, et al. Systematic review: Vitamin D and calcium supplementation in

prevention of cardiovascular events. Ann Intern Med. 2010 Mar

2;152(5):315-23. <http://list.netatlantic.com/t/51207408/88831687/126828/0/>

Dr. Wang concluded, “To date, evidence from prospective observational

studies and randomized controlled trials suggests that vitamin D

supplementation at moderate to high doses may have beneficial effects on

reducing the risk for cardiovascular disease.”

About the same time that the two above meta-analyses were published, Dr.

Brent Muhlestein, director of cardiovascular research at the Intermountain

Medical Center Heart Institute in Murray, Utah, presented a paper at this

year’s American College of Cardiology’s annual scientific session in

Atlanta.

The Utah group studied 31,000 patients over one year and found those with

the lowest vitamin D levels had a 170-per-cent greater risk of heart attacks

than those with the highest levels. Those with the lowest vitamin D

levels also had an 80-per-cent greater risk of death, a 54-per-cent higher

risk of diabetes, a 40-per-cent higher risk of coronary artery disease, a

72-per-cent higher risk of kidney failure and a 26-per-cent higher risk of

depression.

Mittelstaedt, M., Vitamin D may slash risk of heart-disease risk. Globe and

Mail, 3/15/2010 <http://list.netatlantic.com/t/51207408/88831687/126829/0/>

In order to prove that it was the vitamin D, and not a confounder (confusing

fact), Dr. Muhlestein took 9,400 patients and gave them vitamin D, finding a

30% reduced risk of death. He did not think it was ethical to withhold

vitamin D in a placebo control group, in order to do a randomized controlled

trial.

This Utah study is unique in that these remarkable results were obtained in

only one year – not the usual ten years - so the initial 25(OH)D blood test

probably represented an accurate picture of vitamin D health. Dr. Muhlestein

is not waiting for further studies, saying, “My recommendation to all my

patients, and certainly I did it for myself, is to get your vitamin D

checked and if you’re very low or even a little bit low, start taking

supplementation and then get it rechecked.”

My recommendation is if you have cardiovascular disease – and even if you

don’t – take at least 5,000 IU of vitamin D3 (cholecalciferol) per day and

be sure to have your blood tested periodically for 25-hydroxy-vitamin D.

(You may not need any vitamin D in the summer.) Since you already have a

fatal disease, and cardiovascular disease is a fatal disease, maintain your

25(OH)D levels in the high normal range, 70-100 ng/ml, not the mid-normal

range, 50-70 ng/ml, you want if you are healthy.

Remember to obtain a copy of your 25-hydroxy-vitamin D [25(OH)D] blood test

report to guarantee your doctor ordered the correct test. Too many doctors

are still ordering the wrong test, a1,25-dihydroxy-vitamin D, thinking they

are checking for vitamin D deficiency, when they are doing nothing but

falsely reassuring you and wasting your money. Get an actual copy of your

lab report and be sure it says 25-hydroxy-vitamin D or 25(OH)D.

Also, remember that vitamin D needs numerous co-factors to work in the body.

The ones you have to worry about are magnesium, zinc, boron and vitamin K

because many people are deficient in these four nutrients. You can get these

by simply eating a handful of seeds and nuts every day, while being careful

to eat green leafy vegetables once a day.

At least one professor is having none of this. Dr. Lenore Buckley of

Virginia Commonwealth University thinks vitamin D may do cardiovascular

harm, even at low doses. She also thinks vitamin D supplementation should be

racial, with Whites getting more than Blacks, Whites enough to obtain blood

levels of 20-30 ng/ml, and Blacks enough to only obtain levels of only 15

ng/ml.

Jancin B. Skepticism Mounts on Need for Vitamin D Supplementation. Family

Practice News Volume 40, Issue 3, Pages 1-2 (15 February

2010)<http://list.netatlantic.com/t/51207408/88831687/126830/0/>

Dr. Buckley quotes two papers only. One – on calcium supplementation alone –

was a randomized controlled trial while the second paper on vitamin D levels

was cross-sectional, meaning it was a picture in time. In the first paper,

Dr. Mark Bolland and colleagues of the University of Auckland gave 1,000 mg

of calcium citrate over five years to 700 women in the treatment group who

were already getting 800 mg/day of calcium in their diet and compared the

treatment group to placebo controls who were getting 800 mg/day of calcium

from their diet alone. So the study compared 1800 mg/day to 800 mg/day.

Bolland MJ, et al. Vascular events in healthy older women receiving calcium

supplementation: randomised controlled trial. BMJ. 2008 Feb

2;336(7638):262-6.<http://list.netatlantic.com/t/51207408/88831687/126831/0/>

They found 1800 mg/day of calcium may well do harm, with apparent increased

rates of cardiovascular disease. However, they excluded anyone with frank

vitamin D deficiency, exactly the patients who may benefit the most from

extra calcium. (The extra calcium may decrease renal metabolic clearance of

the little vitamin D such patients have.) The real problem came when they

tried to verify the reported cardiovascular events with the national

database in New Zealand; their findings were then of marginal significance

(P=.05).

The authors noted that previous studies of total calcium intake (both diet

and supplements), such as the Boston Nurses Study or the Iowa Women’s Health

Study have both found that women with the highest total calcium intake had

either the lowest death rates or the lowest cardiovascular disease. That

said, it seems it is better to get your calcium from your diet and not from

a pill, always a good rule.

This is a good time to say that vitamin D sufficient adults need about 1,000

mg of calcium a day from all sources, including diet and supplements and

even that recommendation is based largely on studying vitamin D deficient

people. In my opinion, no vitamin D sufficient person should be taking 1,000

mg of calcium/day in supplements, unless they get zero from their diet,

pretty difficult to do.

NIH: Dietary Supplement Fact Sheet:

Calcium<http://list.netatlantic.com/t/51207408/88831687/126832/0/>

No one knows how much calcium supplements vitamin D sufficient older people

need to take, but it is undoubtedly less than 1200 mg/day the NIH

recommends, as someone with a 25(OH)D level of 32 ng/ml absorbs a lot more

calcium than does someone with a level of 10 ng/ml. If you want an answer to

the question of vitamin D/calcium interactions, the person to ask is

Professor Heaney and I know where you can ask him. Dr. Heaney is

speaking to an all-day Grassroots Health seminar on vitamin D in San Diego

on Friday, April 9, 2010. His talk is “Interactions: vitamin D, calcium and

safety.” Please tell me what he says.

Diagnosis & Treatment of Vitamin D Deficiency Seminar

<http://list.netatlantic.com/t/51207408/88831687/119250/0/>

Getting back to Dr. Lenore Buckley of Virginia Commonwealth University, she

based her racial recommendations (Blacks should be given less, not more,

than Whites) entirely on a single cross-sectional study by Dr. Barry

Freedman and colleagues at Wake Forest University (In the spirit of full

disclosure, Wake Forest University is my old nemesis as I am a UNC grad).

Freedman BI, et al. Vitamin d, adiposity, and calcified atherosclerotic

plaque in african-americans. J Clin Endocrinol Metab. 2010

Mar;95(3):1076-83.<http://list.netatlantic.com/t/51207408/88831687/126833/0/>

Dr. Freedman and his Wake forest colleagues measured vitamin D levels and

plaque (the build-up in your arteries) on 340 diabetic obese (BMI 35)

African Americans and found higher vitamin D levels were associated with

more plaque build up in the arteries.

I feel sorry for Dr. Freedman at Wake Forest but not for Dr. Buckley, the

physician who decided that one Wake Forest study was enough to keep her

black patients vitamin D deficient. Dr. Buckley, in considering only one

vitamin D study, has decided to treat her African American patients

different then her white patients. She apparently gave no consideration to

the thousands of vitamin D studies in other diseases, and no consideration

to the other calcification and plaque study, this one a much larger and

better controlled (prospective cohort controlled study), published 8 months

ago.

de Boer IH, et al. 25-hydroxyvitamin D levels inversely associate with risk

for developing coronary artery calcification. J Am Soc Nephrol. 2009

Aug;20(8):1805-12.<http://list.netatlantic.com/t/51207408/88831687/126834/0/>

Dr. Ian de Boer and colleagues at the University of Washington studied 1370

patients for three years finding coronary calcifications are indeed

associated with vitamin D deficiency, concluding that “each 10-ng/ml lower

25(OH)D concentrations was associated with a 23% increased risk” for

developing calcification. And, in direct contradiction to the Wake forest

study, Dr. de Boer found the 201 vitamin D deficient black patients were

more likely, not less likely, to develop such plaque then the Whites were.

Getting back to the Wake Forest study, why did their group get such

different results than the researchers at the University of Washington? When

I looked at Figure 1 in the Wake Forest study, the 25(OH)D measurements were

all over the place, including about 30 Black patients with 25(OH)D levels

greater than 40 ng/ml and one with a level of 90 ng/ml. The way the Wake

Forest study was designed, a few bogusly elevated 25(OH)D levels will

invalidate all their results.

One only has to look at the Wake Forest group’s methods section. Unlike the

Washington study, which used the gold standard to measure vitamin D

(DiaSorin RIA), Wake Forest decided to send their samples out to, you

guessed it, Quest Diagnostics.

For new readers, this newsletter was the first to report Quest’s 25(OH)D

results were suspicious, in a July 2008 newsletter.

The Vitamin D Newsletter, Supplementing with Vitamin D, July

2008<http://list.netatlantic.com/t/51207408/88831687/117117/0/>

The New York Times picked up on the story six months later.

Pollack A. Quest Acknowledges Errors in Vitamin D Tests January 7, 2009 The

New York Times <http://list.netatlantic.com/t/51207408/88831687/126835/0/>

Since the New York Times story, Michel, editor of the Dark Report had

24 Aliquot samples (small amounts of the same blood drawn at the same time)

sent to labs all over the country for a vitamin D test. Quest’s results

varied from 36 ng/ml to 66 ng/ml, on the same blood sample. The good news

was the methods used by LabCorp all clustered around 44 ng/ml.

After the New York Times story, Quest assured me they have fixed their test.

But I don’t know how Quest can run a million 25(OH)D tests every year on

complicated mass spec machines that require meticulous sample preparation

and highly trained operators, while requests for additional tests mount next

to the operators. (In the spirit of full disclosure, I used to be a paid

consultant for DiaSorin but have decided not to exercise my contract.)

Quest Diagnostics says they have fixed their diagnostic vitamin D testing.

If they haven’t, look at the consequences. Researchers at Wake Forest relied

on Quest and Dr. Buckley relied on Wake Forest and is now treating her black

patients different than her white patients, keeping her black patients

vitamin D deficient. Some of Dr. Buckley’s black patients will die from

vitamin D deficiency.

The first thing Wake Forest needs to do is take the same frozen samples they

sent to Quest Diagnostics and send them to LabCorp, which uses a reliable

and idiot proof DiaSorin testing method. I predict many of Wake forest’s

high 25(OH)D levels are, in reality, much lower, invalidating their

findings.

You can help. Email Dr. Freedman and ask him to retest his samples using a

DiaSorin method (bfreedma@....)

Second, call around and find out which lab in your area uses Quest. At the

same time, find out which lab in your area uses LabCorp or call Life

Extension Foundation at 1- (Life Extension uses LabCorp). Then

have your 25(OH)D drawn on the same day. This will cost you, in total,

several hundred dollars. (If you can’t afford it, the Vitamin D Council will

pay $100.000 of your total costs, once you send me copies of both Quest’s

and LabCorp’s reports and your receipts.)

We need about 30 duplicate blood samples. We need copies of both Quest’s and

LabCorp’s actual 25(OH)D lab reports, drawn on the same day. I will publish

the findings in this newsletter, no matter what they show. The lives of

thousands of African Americans may be at stake.

And yes I have thought about what vitamin D could do for health care, and

yes I have thought about what it could do for health care costs, and yes I

have thought about what it could do to lower the accelerated death rate

among Blacks, and yes I have written newsletters about it, and yes I have

contacted the Obama administration and no, no one has answered my pleas.

Cannell, MD

Executive Director

Vitamin D Council

--

Ortiz, MS, RD

" Nutrition is a Science, Not an Opinion Survey "

" I'm still in my first marriage. I know it's wrong to talk about it so

temporary like that. My current husband hates it when I do that. " :-)