Saturday, April 21, 2007

The Toxic Effects of Sugar

What is the problem with sugar?
I recently read the results of a major European study which found that women with high blood sugar levels are at an increased risk of developing cancer.
The study, which looked at 64,500 people over the course of 13 years, linked high blood sugar with cancers of the pancreas, skin, womb, and urinary tract. High blood sugar was also linked to breast cancer for women under 49.
Women in the top quarter of blood sugar readings had a 26 percent higher chance of developing cancer than those in the bottom quarter.
See Diabetes Care, Vol. 30, No. 3, March 2007: 561-567
We all know that sugar causes cavities and as an “empty calorie” adds no nutritional problem is value to our diet. We tend to think of cutting back as eating less those around us. The problem is that even if we eat ½ of what those around us eat, we are still eating an enormous amount of sugar. Since the early 1800's, the average sugar consumption has increased from approximately 12 pounds per person annually to 124 pounds in 1980 and to 152 pounds in 1997. It is estimated that 75 percent of all sugar we consume comes from processed food.
Harmful Effects of Sugar
Increased risk of diabetes
Increased risk of cancer
Increased free radical formation
Increased in advanced glycation end products (AGEs)
Increased risk of cardiovascular disease

A. Increase in Diabetes
This type of diabetes that afflicts adults has risen 33 percent in the past decade alone. Three out of every 50 adults are now affected with the serious, but still curable, diet-linked condition, according to studies by the Centers for Disease Control and Prevention.
Sugars and starches increase insulin which leads to a decrease in insulin receptors in the cell and the development of insulin resistance. This leads to increased blood pressure, obesity, heart disease and diabetes
Insulin also increases appetite and blocks the release of serotonin, a neurotransmitter in the brain that informs the body to slow down eating. Without serotonin, there is a tendency to overeat, which then leads to a spiral of excessive sugar intake.
B. Increase in Cancer
Sugar feeds cancer:
For example, a study using a mouse model of human breast cancer showed that tumors are quite sensitive to blood-glucose levels. Sixty-eight mice were injected with an aggressive strain of breast cancer. They were then fed diets to induce either high blood-sugar (hyperglycemia), normal, or low blood-sugar (hypoglycemia). There was a dose-dependent response, the lower the blood glucose level, the greater the survival rate. It was shown that after 70 days, eight of the 24 hyperglycemic mice survived compared to 16 of 24 normal glycemic and 19 of 20 hypoglycemic mice. This suggests that the restriction of sugar intake is the key to slowing the effects of breast tumors.
Consider the million-dollar positive emission tomography device, or PET scan, which is regarded as one of the ultimate cancer-detection tools. PET scans use radioactively labeled glucose to detect sugar-hungry tumor cells.
C. Increase in Free Radicals and Reduced Antioxidants
Many studies have shown that a direct correlation exists between sugar and free radical formation.
A study from the University at Buffalo, published in the Journal of Clinical Endocrinology and Metabolism in August 2000, showed that excess sugar in the bloodstream stimulates the production of free radicals. In this study, researchers gave 14 healthy men and women who had fasted for 12 hours a drink containing 75 grams of glucose. The sugar content is equivalent to that in two cans of soda. Researchers then took blood samples from all participants before the glucose challenge and again at various intervals thereafter.
Diseases that result from free radicals include many age related illness such as atherosclerosis, dementia, cancer, arthritis, autoimmune disease, etc. Excess sugar generates free radicals indirectly. Excess sugar is converted into triglycerides and cholesterol in the liver. The excessive cholesterol and free fatty acid (FFA), when released in order to generate energy for the body, causes the production of free radical metabolites that inhibit glucose utilization by the muscle.
D. Increase AGEs (Advanced glycation end products)
AGEs are substances formed when blood sugar (glucose) attaches itself to proteins in the body's tissues. This results in cross-linked hard yellow-brown AGE compounds. Negative effects of AGEs include thickened arteries, stiff joints, feeble muscles, and failing organs. This is especially evident in elderly people. Diabetics suffer a very high incidence of nerve, artery, and kidney damage because their high blood sugar levels greatly accelerate the chemical reactions that form AGEs. The evidence is clear that sugar induced AGE’s make us age faster.
E. Increase in Heart Disease
Between 1910 and 1970, coronary heart disease escalated from a yet-to-be recognized problem to one of the most deadly diseases of the past century. Due to better consumer education, the intake of animal fat and butter dropped significantly while the intake of cholesterol remained unchanged in the past fifty years. The intake of refined carbohydrates (mainly sugar, fructose from corn syrup and white flour) however, increased significantly.
The increasing incidence of cardiovascular disease closely parallels the increasing consumption of sugar and not with the consumption of animal fat (saturated fat) or of total fat.
Epidemiological studies repeatedly confirm that in populations where sugar intake is high, there is a correspondingly higher risk of developing heart disease. The Masai tribe of East Africa and the Eskimos of North American have a diet consisting mainly of milk and meat that is high in fat. Yet they have a very low incidence of heart disease. In the past, coronary disease was considered rare among the black population in South Africa. However, during the past few decades, their consumption of sugar has increased greatly and so has the incidence of coronary artery disease. In Iceland, heart disease (and diabetes) was almost unheard of until the 1930s, although the Icelanders diet is tremendously high in fat.
Surgeon Captain T.L. Cleave, who wrote the classic study The Saccharine Disease, provides ample evidence that the coronary artery disease epidemic today could be traced to increases in refined carbohydrate intake. It takes about 20 years of continuous insult of sugar to produce pathological disease such as heart attacks and diabetes. Known as the Cleave's Rule of 20 years, the arrival of modern day atherosclerosis, diabetes, and other degenerative disease reflects the concurrent rise in refined carbohydrate intake 20 years earlier, as in the case of many modern civilizations. In Yugoslavia and Poland, the development of high heart disease rates since the mid 1950s was associated with a concurrent quadruple increase of sugar intake and occurred despite a fall in animal fat intake.
The inescapable conclusion is that coronary artery disease was a rare illness in the 19th century. It was a disease started in 1912, and arrived right on schedule in accordance to Cleave's Rule of 20 years (when the cola revolution was started in the 1890s and the introduction of four mills to produce refined flour).
The fact is that a high sugar intake is linked to an increased risk of heart disease. Simple sugars are the primary source of high triglycerides, a type of blood fat, and very low-density lipoproteins (LDL), which are an independent risk factor for atherosclerosis. Sugar lowers good HDL cholesterol and raises bad LDL cholesterol and blood pressure levels. It is estimated that a high sugar intake may account for as many as 150,000 premature deaths from heart disease in the US each year.
Studies have been conducted to support this. In one research trial, 18 male subjects received normal food followed by a rigorously specified diet in which protein and carbohydrate requirements were met by amino acids, essential fat, and glucose. The average concentration of cholesterol in the initial period, on normal food, was 227 mg/dl. After two weeks on the restricted glucose diet, it had dropped to 173. Two weeks later, the level was at 160. When the diet was altered by replacing 25 percent of the glucose with sucrose (while all other dietary constituents kept constant), the average cholesterol level rose from 160 to 178 within one week and to 208 within two weeks. The researchers carried the study one step further. The sucrose was replaced with glucose again. With this change, the cholesterol concentration dropped back to 175 within one week and the decline continued. It finally leveled off at 150 mg/dl, which was 77 mg/dl less than the initial value. This research finding links the consumption of sucrose (table sugar) directly to increased cholesterol. The exact mechanism is still under research.
In addition to glucose, fructose also raises blood triglyceride level. In a clinical trial conducted at the University of Minnesota, researchers followed 24 healthy adults who received one of 2 diets assigned randomly for a period of 6 weeks and then switched back to the other diet for 6 weeks. One diet provided 17% of energy as fructose and the other diet was sweetened with glucose and was absent of fructose. Both diets contain common foods and contained nearly identical amounts of the macronutrients. The researchers found that in men, the fructose diet raised plasma triglyceride levels by 32%, although there was no effect seen with the women being studied.
Elevated triglyceride blood level of in itself is a strong and independent risk factor for heart attack among middle-aged and elderly men. In fact, studies have shown that blood triglyceride level was a stronger risk factor than total cholesterol alone. It is not known why women appear to be immune to this other than postulations that the high level of estrogen acts as a protective factor. The exact mechanism is still under investigation.
How about cholesterol and fat as risk factors for cardiovascular disease? For decades, we were told that cholesterol was the culprit in atherosclerosis, and for good reasons, since arthrosclerotic plaque is found to be rich in cholesterol. The logic that dietary cholesterol in diet leads to serum cholesterol appeared to make perfect sense.
Over the past 40 years, our knowledge of the origin of atherosclerosis has increased exponentially. Many studies have failed to show that a change in the amount of cholesterol in the diet had any significant effect on the incidence of heart disease. In fact, the correlation between diet cholesterol and serum cholesterol level is indeed weak. Furthermore, cholesterol is an important macronutrient necessary for hormonal synthesis and cell membrane stabilization. A low cholesterol level (below 150 mg/dl) has been linked with an increased cancer risk. Cholesterol in its natural form when made by the liver is an antioxidant and thus of great benefit to the body. It is only when oxidized cholesterol is eaten that the cholesterol becomes bad.
Based on false logic, it was believed that diets concentrating on lowering total serum cholesterol level would reduce coronary heart disease risks. This belief is valid if the cholesterol being lowered is LDL cholesterol only. Unfortunately, most popular low-fat, high-carbohydrate diets lower both HDL cholesterol as well as LDL cholesterol. No cardiovascular risk reduction is achieved as the LD:HDL ratio remained constant. It must be remembered that cardiovascular risk is inversely related to HDL cholesterol level and directly proportional to LDL cholesterol level." In other words, the higher the HDL cholesterol, the lower the risk, and the higher the LDL cholesterol level, the higher the risk.
This is further complicated by the fact that consumers are often unclear as to what constitutes fat. There are different kinds of fat as there are different kinds of cholesterols. Monounsaturated fat such as olive oil is good. Natural unhydrogenated polyunsaturated fat, such as nuts and seeds, is good as well. Cold-water fish, such as salmon, for example, contain an abundance of this kind of fat with its active component omega-3 fatty acid, which is cardio protective. These two kinds of fats have been shown to reduce cardiovascular disease risk by 19 percent and 38 percent respectively in clinical studies.
Saturated fat is somewhat more complicated. It is derived from animal and diary products that are commercially raised. Unfortunately, commercially raised animals, such as poultry, are laced with hormones, antibiotics, and are grain fed. They have a higher level of saturated fat in their meat. Saturated fat from this source has been linked to a 17 percent increase in cardiovascular disease risk in some studies. Saturated fats from free-range animals are the preferred way. The amounts of saturated fat in organic eggs, for example, are much lower than that in commercial eggs.
The worse kind of fat is trans fat. This fat is produced when polyunsaturated vegetable fats are artificially hydrogenated, a process that increases the firmness of the oil and its resistance to oxidative damage. Trans fat is commonly used in cakes, donuts, fast foods, and fried foods. Trans fat has been linked to the highest risk of cardiovascular disease. Studies have shown that replacing 2 percent of energy eaten in the form of trans unsaturated fat with unhydrogenated, unsaturated fat, such as nuts, olive oil, and flaxseed oil, drops heart disease risk by 53 percent.
Cholesterol is not bad for you, and certain types of fat are good for health. Sugar, on the other hand, should be avoided.
I recommend completely avoiding Sucrose, Fructose (especially high fructose corn syrup), Artificial Sweetners and high Glycemic index /load foods

There are two common ways to classify carbohydrates:

Simple versus Complex Carbohydrates
High versus Low Glycemic Carbohydrates

A. Simple versus Complex Carbohydrates

All carbohydrates are broken down into sugar inside the body. It is the rate and the amount of this dissolution that determines the level of sugar in the blood. Complex carbohydrates such as green leafy vegetables, brown rice, potato, whole grain products, legumes, and fruits break down slowly, thus causing a gradual rise and fall in blood sugar. Generally speaking, most complex carbohydrates are considered good for health.
Simple carbohydrates such as cakes, white rice, and ice cream break down quickly once inside the body. This causes rapid spikes in blood sugar levels and subsequent valleys when the sugar is absorbed. Most simple carbohydrates are detrimental to our health.

This simple and easily comprehensive classification of carbohydrates is however incomplete. While most simple carbohydrates are harmful, some complex carbohydrates, such as potato starch, are also not good for health because of their relatively fast rate of breakdown which leads us to the second way of looking at carbohydrates, glycemic index.

B. High vs. Low Glycemic Index (GI) Foods

Another popular way to classify carbohydrates is the use of the glycemic index. This index is a measure of how a given food affects the blood-glucose levels. Each food is assigned a numbered rating. The index measures the entry rate of a carbohydrate into the bloodstream. The lower the rating, the slower the digestion and absorption process and the better it is for the body. This means a healthier and more gradual release of sugars into the bloodstream. Conversely, a high rating implies that blood-glucose levels are increased quickly, which stimulates the pancreas to secrete insulin to normalize blood-sugar levels. This rapid fluctuation of blood-sugar levels is unhealthy because of the amount of stress placed on the body.

The glycemic index of an individual carbohydrate serves only as a general guide. Nevertheless, this classification gives us a general understanding of which types of food breaks down faster and is therefore harmful to health. Similarly, the index also provides an indication of which kinds of foods breakdown slowly and are thus essential for anti-aging.

By using the glycemic index alone, one could misinterpret that a cup of low fat ice cream is healthier than a baked potato. This is because the glycemic index of low fat ice cream (glycemic index of 50) is actually lower than that of a baked potato (glycemic index of 85). This is obviously an incorrect conclusion.

The primary factors that determine the glycemic index are the structure of simple sugars in the food, soluble fiber content, fat content and the level of food processing.

Generally speaking however, selecting carbohydrates with a low to moderate glycemic index is an important part of a healthy eating program. The lower the index, the slower the rate of absorption.

The University of Sydney maintains a helpful database of the GI of foods at:

As the website points out, low glycemic index foods:

Low GI diets help people lose and control weight
Low GI diets increase the body's sensitivity to insulin
Low GI carbs improve diabetes control
Low GI carbs reduce the risk of heart disease
Low GI carbs reduce blood cholesterol levels
Low GI carbs can help you manage the symptoms of PCOS
Low GI carbs reduce hunger and keep you fuller for longer
Low GI carbs prolong physical endurance
High GI carbs help re-fuel carbohydrate stores after exercise

Glycemic Load
The most important extension of the concept of glycemic index is called the glycemic load, which takes the quantity of available carbohydrates into account. Available carbohydrates are those that provide energy, i.e. starch and sugar, but not fiber. The glycemic load measures the effect of the glycemic index of a food multiplied by its available carbohydrate content in grams in a standard serving. Harvard School of Public Health professor and researcher Walter Willett, M.D., and his associates developed this concept as long ago as 1997, when they published journal articles on the subject. But it was only in their Harvard Women's Health Watch article and Dr. Willett's new book (see bibliography below) that they have published many of the GL numbers. For example, these resources have nice but very short lists of a few foods for which they have calculated the glycemic load (note in particular the high GI and low GL of watermelon). Now, however, Jennie Brand-Miller and her associates at the University of Sydney have calculated the GL of all 750 foods for which GI numbers have been calculated. This table was published originally in the July 2002 issue of the American Journal of Clinical Nutrition, see

Here is a table of the glycemic index of some common foods:

Sugar Alternatives include:

1. Stevia
2. Xylitol and Erythritol

In the future we may be able to use Miracle Fruit. I just learned about a West African berry called Synsepalum dulcificum, only slightly better known as the miracle fruit, has a powerful natural property: Anything you consume for about an hour after eating one tastes sweet, even substances as diverse as goat cheese and rich stout beer.
A protein in the miracle fruit binds to a patient's taste buds, altering the tongue's sweet receptors so they activate when more sour foods are eaten. Experiments intended to genetically engineer the properties of the miracle fruit have largely failed.
The miracle fruit is a bit better known in Japan, as it's sold in freeze-dried, canned and tablet forms there. The movement has spread somewhat stateside, with a modest number of American growers selling cutting and seeds so folks can grow their own plants, as the berries are highly perishable.
Wall Street Journal March 30, 2007

124 Ways Sugar Can Ruin Your Health

Read the following from Nancy Appleton, Ph.D., Author of the book "Lick The Sugar Habit"

In addition to throwing off the body's homeostasis, excess sugar may result in a number of other significant consequences. The following is a listing of some of sugar's metabolic consequences from a variety of medical journals and other scientific publications.

1. Sugar can suppress the immune system

2. Sugar upsets the mineral relationships in the body

3. Sugar can cause hyperactivity, anxiety, difficulty concentrating, and crankiness in

4. Sugar can produce a significant rise in triglycerides

5. Sugar contributes to the reduction in defense against bacterial infection (infectious

6. Sugar causes a loss of tissue elasticity and function, the more sugar you eat the
more elasticity and function you loose

7. Sugar reduces high density lipoproteins

8. Sugar leads to chromium deficiency

9. Sugar leads to cancer of the breast, ovaries, prostrate, and rectum

10. Sugar can increase fasting levels of glucose

11. Sugar causes copper deficiency

12. Sugar interferes with absorption of calcium and magnesium

13. Sugar can weaken eyesight

14. Sugar raises the level of neurotransmitters: dopamine, serotonin, and

15. Sugar can cause hypoglycemia

16. Sugar can produce an acidic digestive tract

17. Sugar can cause a rapid rise of adrenaline levels in children

18. Sugar increases irritable bowel disease

19. Sugar can cause premature aging

20. Sugar can lead to alcoholism

21. Sugar can cause tooth decay

22. Sugar contributes to obesity

23. High intake of sugar increases the risk of Cohn’s disease, and ulcerative colitis

24. Sugar can cause changes frequently found in person with gastric or duodenal

25. Sugar can cause arthritis

26. Sugar can cause asthma

27. Sugar greatly assists the uncontrolled growth of Candida Albicans (yeast

28. Sugar can cause gallstones

29. Sugar can cause heart disease

30. Sugar can cause appendicitis

31. Sugar may increase multiple sclerosis

32. Sugar can cause hemorrhoids

33. Sugar can cause varicose veins

34. Sugar can elevate glucose and insulin responses in oral contraceptive users

35. Sugar can lead to periodontal disease

36. Sugar can contribute to osteoporosis

37. Sugar contributes to saliva acidity

38. Sugar can cause a decrease in insulin sensitivity

39. Sugar can lower the amount of Vitamin E in the blood

40. Sugar can decrease growth hormone

41. Sugar can increase cholesterol

42. Sugar can increase the systolic blood pressure

43. Sugar can cause drowsiness and decreased activity in children

44. High sugar intake increases advanced glycation end products (AGEs)(Sugar
bound non- enzymatically to protein)

45. Sugar can interfere with the absorption of protein

46. Sugar causes food allergies

47. Sugar can contribute to diabetes

48. Sugar can cause toxemia during pregnancy

49. Sugar can contribute to eczema in children

50. Sugar can cause cardiovascular disease

51. Sugar can impair the structure of DNA

52. Sugar can change the structure of protein

53. Sugar can make our skin age by changing the structure of collagen

54. Sugar can cause cataracts

55. Sugar can cause emphysema

56. Sugar can cause atherosclerosis

57. Sugar can promote an elevation of low density lipoproteins (LDL)

58. High sugar intake can impair the physiological homeostasis of many systems in
the body

59. Sugar lowers the enzymes ability to function

60. Sugar intake is higher in people with Parkinson’s disease

61. Sugar can cause a permanent altering the way the proteins act in the body

62. Sugar can increase the size of the liver by making the liver cells divide

63. Sugar can increase the amount of liver fat

64. Sugar can increase kidney size and produce pathological changes in the kidney

65. Sugar can damage the pancreas

66. Sugar can increase the body's fluid retention

67. Sugar is enemy #1 of the bowel movement

68. Sugar can cause myopia (nearsightedness)

69. Sugar can compromise the lining of the capillaries

70. Sugar can make the tendons more brittle

71. Sugar can cause headaches, including migraine

72. Sugar plays a role in pancreatic cancer in women

73. Sugar can adversely affect school children's grades and cause learning disorders

74. Sugar can cause an increase in delta, alpha, and theta brain waves

75. Sugar can cause depression

76. Sugar increases the risk of gastric cancer

77. Sugar and cause dyspepsia (indigestion)

78. Sugar can increase your risk of getting gout

79. Sugar can increase the levels of glucose in an oral glucose tolerance test over the
ingestion of complex carbohydrates

80. Sugar can increase the insulin responses in humans consuming high-sugar diets
compared to low sugar diets

81. High refined sugar diet reduces learning capacity

82. Sugar can cause less effective functioning of two blood proteins, albumin, and
lipoproteins, which may reduce the body’s ability to handle fat and cholesterol

83. Sugar can contribute to Alzheimer’s disease

84. Sugar can cause platelet adhesiveness

85. Sugar can cause hormonal imbalance; some hormones become underactive and
others become overactive

86. Sugar can lead to the formation of kidney stones

87. Sugar can lead to the hypothalamus to become highly sensitive to a large variety
of stimuli

88. Sugar can lead to dizziness

89. Diets high in sugar can cause free radicals and oxidative stress

90. High sucrose diets of subjects with peripheral vascular disease significantly
increases platelet adhesion

91. High sugar diet can lead to biliary tract cancer

92. Sugar feeds cancer

93. High sugar consumption of pregnant adolescents is associated with a twofold
increased risk for delivering a small-for-gestational-age (SGA) infant

94. High sugar consumption can lead to substantial decrease in gestation duration
among adolescents

95. Sugar slows food's travel time through the gastrointestinal tract

96. Sugar increases the concentration of bile acids in stools and bacterial enzymes in
the colon

97. Sugar increases estradiol (the most potent form of naturally occurring estrogen) in

98. Sugar combines and destroys phosphatase, an enzyme, which makes the process
of digestion more dificult

99. Sugar can be a risk factor of gallbladder cancer

100. Sugar is an addictive substance

101. Sugar can be intoxicating, similar to alcohol

102. Sugar can exacerbate PMS

103. Sugar given to premature babies can affect the amount of carbon dioxide they

104. Decrease in sugar intake can increase emotional stability

105. The body changes sugar into 2 to 5 times more fat in the bloodstream than it does starch

106. The rapid absorption of sugar promotes excessive food intake in obese subjects

107. Sugar can worsen the symptoms of children with attention deficit hyperactivity
disorder (ADHD)

108. Sugar adversely affects urinary electrolyte composition

109. Sugar can slow down the ability of the adrenal glands to function

110. Sugar has the potential of inducing abnormal metabolic processes in a normal
healthy individual and to promote chronic degenerative diseases

111. I.Vs of sugar water can decrease oxygen to the brain

112. High sucrose intake could be an important risk factor in lung cancer

113. Sugar increases the risk of polio

114. High sugar intake can cause epileptic seizures

115. Sugar causes high blood pressure in obese people

116. In Intensive Care Units: Limiting sugar saves lives

117. Sugar may induce cell death

118. Sugar may impair the physiological homeostasis of many systems in living

119. In juvenile rehabilitation camps, when children were put on a low sugar diet, there
was a 44% drop in antisocial behavior

120. Sugar can cause gastric cancer

121. Sugar dehydrates newborns

122. Sugar can cause gum disease

123. Sugar increases the estradiol in young men

124. Sugar can cause low birth weight babies

To your health!

Donald P Ellsworth, M.D.
Feel free to pass this information on to others

Tuesday, April 10, 2007

Vitamin D: The Pro-Hormone (and 400 IU is too low)

Vitamin D: The Prohormone – It is not Just for Bones and 400 IU is too little

The more I learn about vitamin D the more I am amazed:

1. Vitamin D is very important. What I learned in medical school only talked
about calcium and bone metabolism. Vitamin D does much more than this.

2. Most of us can easily get enough by spending time in the sun.

3. Almost all of those we test (even those who live in the South) have low vitamin D levels

First a little about how vitamin D works - The Vitamin D Endocrine System
7-Dehyrocholesterol (notice cholesterol is needed here) àPre-Vitamin D3 à (THIS IS WHERE SUNLIGHT COMES IN) Vitamin D3 àLIVER with 25-Hydroxylase à 25-OH-D3 à kidney, Breast, Prostate, Macrophages + other tissues with 1-alpha hydroxylase à 1,25 (OH)2-D3 a.k.a Hormone D because it is a Hormone

Terminology (just to show how confusing it can get)
Alfacalcidol: 1-alpha-hydroxycholecalciferol, 1 alpha (OH)D3.Calcifediol: 25-HCC, 25-hydroxycholecalciferol, 25-hydroxyvitamin D3, 25-OHCC, 25-OHD3.Calcipotriene: Calcipotriol. Calcitriol: 1,25-DHCC, 1,25-dihydroxycholecalciferol, 1,25-dihydroxyvitamin D3, 1,25-diOHC, 1,25(0H)2D3. Cholecalciferol: Activated 7-dehydrocholesterol, colecalciferol, Vitamin D3. Dihydrotachysterol: DHT, dihydrotachysterol 2, dichysterol.Ergocalciferol: Activated ergosterol, Calciferol, Ergocalciferolum, Irradiated ergosterol, Viosterol, Vitamin D2. Paricalcitol: 19-nor-1,25-dihydroxyvitamin D2, Paracalcin.

Physiologic Effects of Vitamin D
- Vitamin D enhances the efficiency of the intestinal absorption of calcium and phosphorus (think of low vitamin D if you see low phosphate level). Vitamin D can increase serum calcium
- Immunomodulation (activated T and B cells also have Vitamin D receptors)
- Anti-inflammatory
- antiproliferative

How do we get vitamin D?
Sources of Vitamin D include:
Very few foods naturally contain vitamin D. Dietary sources include eggs from hens that have been fed vitamin D and fatty fish such as herrings, mackerel, sardines, and tuna. In the US, Canada, and many other countries the main source of dietary vitamin D is fortified milk and other foods. But these are relatively minor sources of vitamin D.
In the 1930s, rickets was a major public health problem in the United States. A milk fortification program was implemented to combat rickets, and it nearly eliminated this disorder in the U.S. About 98% to 99% of the milk supply in the U.S. is fortified with 10 micrograms (equal to 400 International Units or IU) of vitamin D per quart. Although milk is fortified with vitamin D, dairy products made from milk, such as cheese and ice creams, are generally not fortified with vitamin D and contain only small amounts. One cup of vitamin D fortified milk supplies one-half of the recommended daily intake for adults between the ages of 19 and 50, one-fourth of the recommended daily intake for adults between the ages of 51 and 70, and approximately 15% of the recommended daily intake for adults age 71 and over.
Brief exposure to sunlight (about 25% of the amount of time it would take to cause light pinkness to the skin) is the most efficient way to get vitamin D. Skin exposure to the sun provides as much as 80% to 90% of the body's vitamin D stores. Full-body sun exposure can lead to the synthesis of as much as 10,000 units of vitamin D per day. Vitamin D is stored in body fat for use during periods without sun exposure.

If vitamin D can easily be obtained from sunlight why would we be deficient? Several factors converge on us:

1. Sunscreens significantly reduce vitamin D synthesis in the body,
2. Lack of sun exposure - Those above 35 degrees latitude can only make Vitamin D from March- October. The elderly, who generally have less sun exposure and less dietary vitamin D intake, may be at the greatest risk for insufficient vitamin D. Factors such as lack of exposure to sunlight.
3. Skin factors
Dark-skinned people need increased exposure to sunlight to produce the same amount of vitamin D as fair-skinned people, because the skin pigment melanin competes with vitamin D precursors in the skin for photons from UV-B light. This also affects vitamin D in breast milk. The prevalence of hypovitaminosis D was 42.4% among African American women

Age related decline in: skin synthesis of vitamin D, dietary intake, impaired intestinal absorption, and reduced metabolism to active forms of vitamin D by the kidneys. Also, vitamin D receptors seem to decrease with age.

Fat Malabsorption also decreases Vit D

Rickets Returns!
In children, vitamin D deficiency causes rickets. Rickets is a bone disease characterized by a failure to properly mineralize bone tissue. Rickets results in soft bones and skeletal deformities . Rickets has recently reemerged, in particular among African American infants and children. In 2003, a report from Memphis, Tennessee, described 21 cases of rickets among infants, 20 of whom were African-American. Prolonged exclusive breastfeeding without vitamin D supplementation is one of the most significant causes of the reemergence of rickets.
Vitamin D deficiency is common in adults as well. Most of us are suboptimal in our vitamin D status which can cause:
Osteoporosis (painless) or osteomalacia (very painful). Note: Vitamin K is also very important.40-60% of individuals with fibromyalgia are vitamin D deficient. A lack of Vitamin D results in the swelling of the bone matrix and this causes intense pain (the Jello effect). With osteomalacia muscle pain and proximal muscle weakness with symptoms such as sensation of heaviness in the legs, rapid fatigue, and problems with climbing stairs and getting up from a chair.
Autoimmune Disease
Your vitamin D level should NEVER be below 32 ng/ml. Any levels below 20 ng/ml are considered serious deficiency states and will increase your risk of breast and prostate cancer and autoimmune diseases like MS and rheumatoid arthritis.
This correlates with 1000-5000 IU Vitamin D3 levels of >75 nmol/liter
It is all about energy – the sun. . In models of autoimmune disease, vitamin D seems to act as an immunomodulator. This might explain why increased vitamin D intake is associated with a lower risk of rheumatoid arthritis.
Vitamin D is converted to 1,25 Dihidroxy- D3 which inhibits the proliferation of benign and malignant There is some epidemiological evidence that people with vitamin D deficiency might be at an increased risk of colon, breast, and prostate cancer.
One estimate is that 23,000 American lives could be saved yearly by adequate sunlight exposure and/or vitamin D supplementation.
Vitamin D for Cancer Treatment?
Vitamin D is converted to 1,25 Dihidroxy D3 which inhibits the proliferation of benign and malignant Prostate cells
Prevent steroid related bone loss (think of this when we are going up on Cortisol or Armour?)
Decreases Blood Pressure (UVB decreases BP by 6 mmHg)
High blood pressure and heart attacks are more common in winter months and in locations farther away from the equator (conditions where sunlight is less ample). People with higher blood levels of vitamin D had naturally lower blood pressures. Vitamin D is known to lower a blood pressure raising substance in the body called angiotensin II. If your blood 25-OH-vitamin D levels is lower than 34 ng/ml your risk of heart attack is doubled, compared to people whose levels are above 34.
Osteoarthritis - Studies showed knee and hip arthritis worsened faster in patients with 25-OH-vitamin D levels below 30 ng/ml.
Improves psoriasis and probably most inflammatory conditions
SAD Depression - Studies showed vitamin D supplementation is equally or more successful in treating Seasonal Affective Disorder compared with use of a lightbox.
Decreases the risk of type 1 diabetes 4 fold (important for infants)
Decreases the risk of MS by 40%
Migraines - Women with migraines who test as deficient in vitamin D often have improvement in their migraines if they begin taking vitamin D and calcium daily.
Musculoskeletal - Several studies showed that patients with persistent muscloskeletal pain and low back pain had vitamin D deficiency and their pain improved when they took vitamin D supplements.
Polycystic Ovary Syndrome and Infertility - Calcium and Vitamin D supplementation helped all the patients with PCOS and infertility after vitamin D deficiency in one small study.
Other conditionsDiabetes, insulin resistance, epilepsy, Graves disease, ankylosing spondylitis, systemic lupus erythematosis, obesity, and rheumatoid arthritis are some other conditions that have been associated with deficiency of vitamin D and/or improvement with vitamin D supplements.
- Raises Phosphate levels
- Decreases PTH level (think of Vitamin D with high calcium that could be increased PTH)
- Improves the treatment of TB
- Decreases CHF
-treat Osteogenesis imperfecta
Dosing Vitamin D
The correct form of vitamin D to take is vitamin D3 (not D2) – this is what we have in Physicians Preference, 1000 IU / cap. Most need 2000-5000 IU a day
While it is true that vitamin D has potential for overdose, researchers are now presenting evidence that it is actually required and safe at dosages of 4,000-5,000 IU per day for adults. Dosage of 100,000 IU daily for several months in adults and 40,000 IU daily in infants for 1-4 months are likely to be toxicity inducing. You may be susceptible to toxicity at lower dosages if you have excess blood calcium levels, hyperparathyroidism, hyperthyroidism, granulomatous diseases such as sarcoidosis, Crohn’s disease, tuberculosis and certain cancers.
Vitamin D toxicity
The symptoms of vitamin D toxicity are loss of appetite, nausea or vomiting, feeling nervous or weak, itching, excessive thirst, increased urination, and elevated blood calcium levels. However, if you are supplementing with vitamin D, you probably can avoid toxicity by having your doctor regularly monitor your blood calcium and vitamin D levels. To your health!

Donald P Ellsworth, M.D.
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